emergency medicine research papers

Global research highlights

• Published: 27 August 2024

Cite this article

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save.

• Get 10 units per month
• Download Article/Chapter or eBook
• 1 Unit = 1 Article or 1 Chapter
• Cancel anytime

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Rights and permissions

Reprints and permissions

About this article

Global research highlights. Can J Emerg Med (2024). https://doi.org/10.1007/s43678-024-00766-5

Download citation

Published : 27 August 2024

DOI : https://doi.org/10.1007/s43678-024-00766-5

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Find a journal
• Publish with us
• Track your research

Log in using your username and password

• Search More Search for this keyword Advanced search
• Latest content
• Current issue
• BMJ Journals

You are here

• Online First
• Comparative treatment of homeless persons with an infectious disease in the US emergency department setting: a retrospective approach
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

• Jessica Barnes 1 ,
• Larry Segars 2 ,
• Jason Adam Wasserman 3 ,
• Patrick Karabon 4 ,
• http://orcid.org/0000-0002-4739-7127 Tracey A H Taylor 3
• 1 Family Medicine , University of Michigan Health System , Ann Arbor , Michigan , USA
• 2 Basic Sciences , Kansas City University , Kansas City , Missouri , USA
• 3 Foundational Medical Studies , Oakland University William Beaumont School of Medicine , Rochester , Michigan , USA
• 4 Oakland University William Beaumont School of Medicine , Rochester , Michigan , USA
• Correspondence to Dr Tracey A H Taylor, Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA; tataylor2{at}oakland.edu

Background Research has long documented the increased emergency department usage by persons who are homeless compared with their housed counterparts, as well as an increased prevalence of infectious diseases. However, there is a gap in knowledge regarding the comparative treatment that persons who are homeless receive. This study seeks to describe this potential difference in treatment, including diagnostic services tested, procedures performed and medications prescribed.

Methods This study used a retrospective, cohort study design to analyse data from the 2007–2010 United States National Hospital Ambulatory Medical Care Survey database, specifically looking at the emergency department subset. Complex sample logistic regression analysis was used to compare variables, including diagnostic services, procedures and medication classes prescribed between homeless and private residence individuals seeking emergency department treatment for infectious diseases. Findings were then adjusted for potential confounding variables.

Results Compared with private residence individuals, persons who are homeless and presenting with an infectious disease were more likely (adjusted OR: 10.99, CI 1.08 to 111.40, p<0.05) to receive sutures or staples and less likely (adjusted OR: 0.29, CI 0.10 to 0.87, p<0.05) to be provided medications when presenting with an infectious disease in US emergency departments. Significant differences were also detected in prescribing habits of multiple anti-infective medication classes.

Conclusion This study detected a significant difference in suturing/stapling and medication prescribing patterns for persons who are homeless with an infectious disease in US emergency departments. While some findings can likely be explained by the prevalence of specific infectious organisms in homeless populations, other findings would benefit from further research.

• HOMELESS PERSONS
• Health inequalities
• PUBLIC HEALTH

Data availability statement

Data are available in a public, open access repository. The dataset used in this study was from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2007 to 2010, emergency department subset, administered by the Centers for Disease Control and Prevention (CDC). reference: [dataset] 15. Centers for Disease Control and Prevention. NAMCS/NHAMCS—Ambulatory Health Care Data Homepage. https://www.cdc.gov/nchs/ahcd/index.htm . Published 2017. Accessed 20 December 2017.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/jech-2023-220572

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

WHAT IS ALREADY KNOWN ON THIS TOPIC

Homelessness and infectious diseases are both important public health issues. There is a gap in knowledge regarding the comparative treatment that persons who are homeless and have an infectious disease receive.

WHAT THIS STUDY ADDS

Homeless persons with an infectious disease in the USA had higher odds of receiving sutures or staples, ‘other procedures’, amebicide agents, antimalarials agents, tetracycline agents and glycopeptide agents, and lower odds of being provided medications for infectious diseases compared with privately housed persons during an emergency department visit.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

These findings provide a platform for continual public health research, potentially providing quality improvement measures for the emergency medical care for homeless persons with infectious diseases.

Introduction

Homelessness is a critical public health concern as 1.5 million individuals spend at least one night in transitional housing or an emergency shelter each year in the USA. 1 As of 2019, over 567 000 individuals were homeless on a single evening in the USA. 2 Homelessness is a complex term with many accepted definitions. The United States Housing and Urban Development definition for homelessness includes any, ‘individual or family who lacks a fixed, regular, and adequate night-time residence’, among many other qualifiers. 3

Homelessness is not homogenous in its distribution as California has 53% of all homeless individuals in the USA. 4 Certain racial groups face disproportionately high rates of homelessness; nearly all minority groups face higher rates of homelessness than their respective percentage of the population. 5 In particular, Black Americans represent approximately 13% of the national population, but comprise 40% of individuals experiencing homelessness. 5 This phenomenon is underpinned by systemic inequities facing minority groups, leading to disproportionate poverty, incarceration, healthcare inequity and housing discrimination—all of which can contribute to homelessness. 5

At its core, homelessness is a public health issue. Homeless individuals have significantly higher morbidity levels compared with their housed peers. In fact, persons facing homelessness die on average 12 years prior to the general US population. 6 Homeless individuals face higher rates of chronic conditions than the general population, ranging from cardiovascular disease to mental illness and are also at higher risk for violence and injury. 1 7 Despite the need and benefit, homeless persons often face access barriers to healthcare, including lack of health insurance and access to routine primary care. 8 Nearly, 75% of homeless persons experienced an unmet healthcare need in the previous year, ranging from medical or surgical care, need for prescription medications, mental healthcare, eyeglasses or dental care. 9 Factors associated with unmet healthcare needs included lack of insurance, past-year employment and food insufficiency—dilemmas disproportionately facing homeless populations and leading individuals to prioritise basic needs over healthcare. 9 Perhaps as a consequence, homeless persons visit emergency departments approximately four times more often than the general population, have high relapsing rates in the emergency room setting and eventually have more admissions to hospital, longer hospital stays and more costly healthcare stays. 8

Part of the increased morbidity facing homeless persons is due to increased rates of infectious diseases. Homeless persons face higher rates of infection by tuberculosis, hepatitis B and C, HIV, scabies, body lice and Bartonella quintana (a louse-borne disease). 7 10 The reasons behind these findings are complex and largely dependent on the specific living conditions of the individual, as well as their unique experiences. Homeless persons living in crowded, shared living spaces are at particular risk for airborne pathogens, such as tuberculosis. 10 There are data to suggest that homeless youth in particular are at higher risk for sexually transmitted infections such as Chlamydia trichamonas . 11–13 A lack of clothing changes combined with crowded, shared living conditions can be conducive to scabies or lice infestations, with subsequent louse-borne illnesses. 10 Previous studies have also demonstrated increased methicillin-resistant Staphylococcus aureus (MRSA) nasal colonisation in homeless individuals using homeless shelters, likely secondary to person-to-person transmission or via fomite transmission. 14 These unique experiences translate to higher rates of particular infectious diseases for individuals facing homelessness.

Interestingly, while there is ample research to demonstrate the high use of emergency department services and infectious diseases among homeless persons, there are little data demonstrating the comparative care that homeless persons receive for these infectious diseases. Our aim was to fill this gap in knowledge by searching for and describing a potential difference in the US emergency department infectious disease treatment between homeless and privately housed persons, by specifically looking for a potential difference in the diagnostic services provided, procedures performed and medication classes prescribed.

Study design

In this retrospective cohort study, we analysed the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2007 to 2010, emergency department data subset. The NHAMCS is administered by the Centers for Disease Control and Prevention, ultimately creating a deidentified, publicly available dataset that spans multiple decades. 15 This study was reviewed by the University Institutional Review Board and deemed to not be human subjects research.

Inclusion criteria

The study population included homeless persons (as denoted via NHAMCS) in the USA who sought emergency department services for an infectious or parasitic disease between the years 2007–2010. This population was compared with non-homeless persons (classified as private residence via NHAMCS). Infectious and parasitic diseases were defined according to the International Classification of Disease 9 codes volumes 1–3; specifically, this included codes 1–139, 176, 320–324, 326, 370, 373, 381–383, 391–392, 420–422, 460–466, 475, 480–488, 510, 513, 522–523, 551, 566, 566–567, 572, 590, 595, 670, 675, 681–682, 684, 686, 730, 771, V01–V06, V08–V09 and V73–V75. 16 There were no specific exclusion criteria but any data not meeting the inclusion criteria were not included in the dataset to be analysed.

Homelessness status (per NHAMCS) was the dependent variable. Non-homeless was defined as those in a private residence, and all other residency statuses (nursing home, other, missing, etc) were coded as missing, thus not included in analysis. Independent variables included diagnostic service variables: complete blood count, liver function tests, blood culture, other blood tests, HIV test, rapid influenza/influenza test, urinalysis, wound culture, other test/service and any imaging—all of which were converted into dichotomous variables. Procedural variables included intravenous fluids, suture/staples, incision and drainage, foreign body removal, pelvic exam, central line, endotracheal intubation and other procedure (each converted into a dichotomous variable). The total numbers of diagnostic services, procedures and medications provided were also investigated. In regards to medications, specific anti-infective medication classes were investigated, including both those provided and those prescribed, by creating dichotomous variables for each anti-infective medication class listed in the 2010 NHAMCS codebook.

Statistical analysis

Homeless and privately housed persons were compared using a complex sample logistic regression analysis for dichotomous variables and via complex sample linear analysis for continuous variables using SPSS software. Nearly, every variable was converted to a nominal variable, signifying if an individual did or did not receive a diagnostic test, procedure or medication class. Following the initial round of testing, analyses were repeated while controlling for potential confounding variables, including patient age, sex, race, ethnicity, HIV status, length of visit, month of visit and if seen in the emergency department in the last 72 hours. For example, homeless patients tend to be older, disproportionately men, have higher ED relapse and so on. Thus, the adjusted odds ratios (ORs) aim to correct for these factors.

The full unweighted sample size of the NHAMCS data set from the years 2007–2010 was 139 502 samples and when selecting for only infectious disease cases, it included 26 220 infectious disease patient visits. Of these, 128 patient visits were classified as homeless with an infectious disease (see online supplemental figure 1 ). According to the data stratification plan, this accounted for the population of the region where each NHAMCS data set was collected from, giving proportionate representation to the diverse regions where these data are collected. Within the infectious disease population, 54% were female and 46% were male. The majority of subjects were adults, with 43.5% of subjects under the age of 18 years old. The majority were non-Hispanic or Latino (66.9%) and identified as white (56%). And 23.4% of subjects identified as Black/African American, followed by Asian (1.7%), American Indian/Alaska Native (0.8%), more than one race (0.7%), and Native Hawaiian or other Pacific Islander (0.4%). Other study findings, after controlling for potential confounding variables, are described below. Additional demographic data for the total homeless patient visits and the total sample dataset are shown in online supplemental table 1 .

Supplemental material

There was not a statistically significant difference detected in diagnostic services provided to homeless persons compared with private residence individuals (including complete blood count, liver function tests, blood culture, other blood test, HIV test, rapid influenza/influenza test, urinalysis, wound culture, other test/service and imaging; figure 1 ), nor in the provision of diagnostic services, nor in the total number of diagnostic services provided.

• Download figure
• Open in new tab
• Download powerpoint

Diagnostic services provided to homeless versus privately housed persons with an infectious disease in US emergency departments. Diagnostic services from the National Hospital Ambulatory Medical Care Survey database with OR shown with 95% CI and p values.

Homeless persons had increased odds (adjusted OR 10.99, CI 1.08 to 111.40, p value: 0.043) of receiving sutures or staples when presenting to a US emergency department with an infectious disease compared with their housed counterparts (see figure 2 ). Homeless persons also had increased odds of receiving ‘other procedures’ (adjusted OR 3.35, CI 1.32 to 8.47, p value: 0.011). Other variables, including intravenous fluids, incision and drainage, and pelvic exam did not demonstrate a statistically significant difference between homeless and privately housed persons. Certain variables, including foreign body removal, central line placement and endotracheal intubation did not contain enough subjects within test parameters to yield usable test results. Complex linear testing on the total number of procedural interventions did not yield a statistically significant result between homeless and privately housed persons.

Procedures performed in homeless versus privately housed persons with an infectious disease in US emergency departments. Performed procedures from the National Hospital Ambulatory Medical Care Survey database with OR shown with 95% CI and p values.

When investigating the medication class provided during an emergency department visit, whether in the emergency department or at discharge, there were several significant differences in the treatment of homeless persons and privately housed persons. As shown in figure 3 , homeless individuals had higher odds of receiving amebicide agents (adjusted OR 5.78, CI 1.03 to 32.32, p value: 0.046), tetracycline agents (adjusted OR: 4.14, CI 1.087 to 15.76, p value: 0.037), antimalarial agents (adjusted OR 4.14, CI 1.09 to 15.81, p value: 0.037) and glycopeptide agents (adjusted OR 5.14, CI 1.56 to 16.89, p value 0.007). Furthermore, homeless persons had lower odds (adjusted OR: 0.29, CI 0.095 to 0.87, p value: 0.027) of being provided a medication in general (not specifically anti-infective agents) compared with private residence persons with an infectious disease. Other variables investigated, as shown in figure 3 , did not demonstrate a statistically significant difference in provision of medications. Certain anti-infective medication classes, including anthelmintics, leprostatics, quinolones, urinary anti-infectives, aminoglycosides, glycylcyclines and carbapenems did not have enough subjects fall within test parameters to yield usable test output.

Medications provided to homeless versus privately housed persons with an infectious disease in US emergency departments. Medications provided from the National Hospital Ambulatory Medical Care Survey database with OR shown with 95% CI and p values.

Following the investigation of medications provided to homeless and private residence individuals, anti-infective medication prescribing was investigated. Homeless persons had higher odds of being prescribed antimalarial agents (adjusted OR: 4.70, CI 1.23 to 17.94, p value: 0.024) and tetracycline agents (adjusted OR: 4.69, CI 1.23 to 17.88, p value: 0.024; figure 4 ). Other variables tested did not demonstrate a statistically significant difference in prescribing habits between homeless individuals and privately housed individuals ( figure 4 ). Certain anti-infective agents, including anthelmintics, antifungals, antituberculosis agents, carbapenems, leprostatics, quinolones, urinary anti-infectives, aminoglycosides, lincomycin derivatives and glycyclines, did not have adequate number of subjects fall within test parameters, thus did not yield usable test output.

Medications prescribed to homeless versus privately housed persons with an infectious disease in US emergency departments. Medications prescribed from the National Hospital Ambulatory Medical Care Survey database with OR shown with 95% CI and p values.

This project sought to detect and describe a potential difference in the management of homeless individuals seeking infection treatment in US emergency departments compared with their housed counterparts. A difference in management (defined as diagnostic services provided, procedures performed and medication prescribed) between these two populations was detected in regards to particular procedures performed, as well as specific medications provided or prescribed.

Diagnostic services

This study hypothesised that there would be a difference in the utilisation of diagnostic services for homeless persons seeking infection treatment in US emergency departments, compared with their housed counterparts. However, a statistically significant difference was not detected ( figure 1 ). These findings do not agree with previous research, which has demonstrated a slight increase in the number of diagnostic services provided to homeless individuals 17 ; however, the research did not specifically look at homeless persons with infectious diseases. Repeated studies with more recent data would be beneficial to elucidate an accurate trend.

This study hypothesised that there would be a significant difference in the procedures performed between homeless and non-homeless populations seeking US emergency department services with an infectious disease. Previous research has demonstrated that homeless young adults (although not those specifically seeking infectious disease treatment) had lower odds of having procedures performed in US emergency departments. 18 In our study, homeless persons presenting with an infectious disease had higher odds of receiving sutures or staples. This finding is perhaps due to clinicians having concerns over access to wound care, wound exposure on leaving the emergency setting and access to primary care treatment on leaving the emergency department. These concerns might lead clinicians to be more aggressive or comprehensive with wound closure via sutures or staples.

Medication provided and prescribed

This study hypothesised that there would be a significant difference in the medications provided to homeless populations seeking infection treatment in US emergency departments compared with their housed counterparts. Homeless persons had higher odds of being provided amebicide, antimalarial, tetracycline and glycopeptide agents. In general, homeless persons had lower odds of being provided a medication when presenting to an emergency department with an infectious disease. To the best of our knowledge, these findings have not been demonstrated in previous studies; however, we have hypotheses as to why these relationships exist.

In regards to amebicide agents, providers might be more apt to cover for amoeba infections in homeless populations due to a concern over increased exposure in outdoor environments or water sources. Thus, a homeless person presenting with a diarrhoeal illness might be more likely to receive a broader range of coverage compared with a privately housed person without potential increased exposure. It is also possible that there is increased prevalence of amoeba infections in homeless populations, thus leading to more treatment in this population; however, to our knowledge this has not been demonstrated In the literature. In regards to antimalarial agents, the reason behind their increased provision to homeless persons with an infectious disease is not immediately clear. Antimalarial medications are indicated for the treatment of a variety of autoimmune conditions, such as systemic lupus erythematous (SLE). Previous research has demonstrated SLE to be more prevalent in African American or Hispanic individuals—populations that also face higher rates of homelessness. 5 19 The variables of race and ethnicity were controlled for in the data analysis, and so should not be the causal factor of our findings in the absence of bias; however, because of the use of this large database, the contribution of bias is not known. We also explored the possibility that immigrants or refugees who are travelling into the USA—and might be exposed to malaria in countries where this pathogen is endemic, thus requiring malarial treatment—might be more prone to homelessness. However, previous research suggests that immigrants and refugees do not face higher rates of homelessness. 20 Thus, this finding remains incompletely explained and warrants further exploration.

Tetracycline agents were more likely to be provided to homeless persons presenting to US emergency departments with an infectious disease. Tetracycline antibiotics are first-line agents for Chlamydial sexually transmitted infections and while previous studies have yielded varied findings on the prevalence of sexually transmitted illnesses in homeless populations, there are data to suggest increased prevalence particularly among homeless youths, who are at increased risk for such illnesses. 12 21 This increased risk for sexually transmitted infections is multifaceted and can be associated with increased likelihood of unprotected sexual intercourse, drug and alcohol use and multiple sexual partners. 12 An increased prevalence of Chlamydial illnesses could explain the increased prescribing of tetracycline agents in this population. Furthermore, several studies have demonstrated serological exposure of homeless persons to a broad range of zoonotic pathogens, including Rickettsia spp and Borrelia spp. 22 23 Tetracycline antibiotics are indicated for many zoonotic infections, infections that homeless persons are perhaps exposed to more frequently due to the sheer nature of being outdoors more than housed populations, as well as living in crowded shelter conditions. 22 23 Beyond this, tetracycline antibiotics are generic (thus relatively inexpensive), effective and avoid the potential for cross-reactivity with penicillin allergies, making them an alluring drug choice in general. 24 Thus, the reasoning behind increased prescribing of tetracycline agents in homeless populations is likely multifaceted.

Glycopeptide antibiotics were provided more frequently to homeless individuals presenting to US emergency departments with infectious diseases. This may be related to the high efficacy in treating MRSA infections. 25 Previous studies have demonstrated that homeless persons face higher rates of MRSA colonisation compared with their housed peers. 14 26–28 This is likely related to the transmissibility of MRSA in crowded living environments; there is also an increased risk of MRSA infections with intravenous drug use, a phenomenon with a significant presence within the homeless community. 26 We hypothesise that the increased prevalence of MRSA exposure and colonisation in the homeless population is what accounts for increased prescribing of glycopeptide agents.

When specifically looking at the differences in the medications prescribed , rather than provided, to homeless persons presenting with an infectious disease, some medication classes ( figure 4 ) did not demonstrate statistically significant differences, including glycopeptide and amebicide agents. Vancomycin (a glycopeptide agent) is given intravenously, thus is more commonly provided within the hospital setting versus as an outpatient. 29 This likely contributes to this change in significance when looking only at prescribed medications. In regards to amebicide agents, it is possible that homeless persons are more likely to be initiated on amebicide therapy while in the emergency setting secondary to concerns over prescription access in the outpatient setting. Previous studies have demonstrated the significant barriers that homeless individuals face in regards to prescription access and medication adherence, which could perhaps lead providers to provide these more in the emergency setting for those facing homelessness. 9 30 31

There are several limitations in this study. By using a database collected by other individuals, there is potential for error and bias in the data collection process outside of our knowledge. This includes the inherent bias of differential likelihood of different populations presenting to the emergency department for care. Furthermore, residency status data may contain errors as it is self-reported by patients and could underestimate the true homelessness rate. 17 Because residency status records recorded as ‘other’ or ‘missing’ were not included in the analyses, this could have introduced some selection bias. Several tests conducted on this project did not have subjects fall within the test parameters and so in these instances, analysis could not be completed. However, given that so many tests were conducted and the majority of them produced valid results, this was deemed acceptable. Many of the findings in this study have not been demonstrated in the literature, and some findings contradict previously reported findings. Given this, repeated studies would be beneficial to support the findings demonstrated.

In conclusion, this study sought to fill a gap in the medical literature regarding the specific care that homeless individuals receive for infectious diseases in US emergency departments compared with privately housed counterparts. Through the use of a retrospective cohort study design using the NHAMCS-ED 2007–2010 database, this study sheds light on the differences in care for homeless persons with infectious diseases in US emergency departments. Homeless persons had higher odds of receiving sutures or staples, ‘other procedures’, amebicide agents, antimalarials agents, tetracycline agents and glycopeptide agents compared with privately housed persons. Homeless persons had lower odds of being provided medications during their emergency department visit. Other variables tested did not demonstrate significant differences. These findings provide a platform for continual public health research with more recent data, potentially providing quality improvement measures for the emergency medical care for homeless persons with infectious diseases.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

Acknowledgments.

This study would not have been possible without the expertise of Amy Smark, MD, Misa Mi, PhD, and the Oakland University William Beaumont School of Medicine Embark Program.

• Pitts SR , et al
• HUD.gov / U.S
• U.S. Code | US Law | LII / Legal Information Institute
• Mahathey A , et al
• National Alliance to End Homelessness
• ↵ Homelessness & health: what’s the connection? 2019 . Available : www.nhchc.org [Accessed 4 Jan 2021 ].
• Geddes JR ,
• Pearson DA ,
• Bruggman AR ,
• Baggett TP ,
• O’Connell JJ ,
• Singer DE , et al
• Badiaga S ,
• Williams SP ,
• Caccamo A ,
• Williams SP
• Shannon CL ,
• Keizur EM ,
• Fehrenbacher A , et al
• Ottomeyer M ,
• Graham CD ,
• Legg AD , et al
• Centers for Disease Control and Prevention
• ↵ STAT!ref: ICD-9-CM - Volumes 1, 2 & 3 . 2015 . Available : http://online.statref.com /Document.aspx?docAddress=vX_cW2IFV8KZKpIum91yWQ%3D%3D&SessionId=27FC3E5RWDUYJWXS&Scroll=1&goBestMatch=true&Index=0&searchContext=infect%7Cc0%7C%7C10%7C1%7C0%7C0%7C0%7C0%7C%7Cc0#H&1&ChaptersTab&zuReHqrSIjsANDKG41vZeg%3D%3D&&110 [Accessed 2 Jan 2018 ].
• Palmer AN ,
• Roberts MH ,
• Clemenzi-Allen AA ,
• Hartogensis W ,
• Cohen SE , et al
• Leibler JH ,
• Zakhour CM ,
• Gadhoke P , et al
• Brouqui P ,
• Liebschutz JM ,
• Keosaian J , et al
• Cardoso LJP , et al
• Landers TF ,
• Harris RE ,
• Wittum TE , et al
• Hunter CE ,
• Farrell S , et al
• Turnbull J ,

Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1
• Data supplement 2

Presented at Poster for the Infectious Diseases Society of America online conference 2020; Oral presentation for the Oakland University Graduate Student Research Conference, Oakland University, Rochester, MI, 2020. Not published in a peer-reviewed manuscript.

Correction notice This article has been corrected since it first published. The middle name has been added for the third author.

Contributors Conception and design of the study: JB, JW, PK and TAHT. Acquisition of data: JW and TAHT. Analysis and/or interpretation of data, drafting the article, revising the article critically for important intellectual content and approval of the version of the manuscript to be submitted: all authors. Guarantor: TAHT.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Read the full text or download the PDF:

• Skip to main content
• Skip to FDA Search
• Skip to in this section menu
• Skip to footer links

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

U.S. Food and Drug Administration

•   Search
•   Menu
• News & Events
• FDA Newsroom
• Press Announcements

FDA Approves and Authorizes Updated mRNA COVID-19 Vaccines to Better Protect Against Currently Circulating Variants

FDA News Release

Today, the U.S. Food and Drug Administration approved and granted emergency use authorization (EUA) for updated mRNA COVID-19 vaccines (2024-2025 formula) to include a monovalent (single) component that corresponds to the Omicron variant KP.2 strain of SARS-CoV-2. The mRNA COVID-19 vaccines have been updated with this formula to more closely target currently circulating variants and provide better protection against serious consequences of COVID-19, including hospitalization and death. Today’s actions relate to updated mRNA COVID-19 vaccines manufactured by ModernaTX Inc. and Pfizer Inc.

In early June, the FDA advised manufacturers of licensed and authorized COVID-19 vaccines that the COVID-19 vaccines (2024-2025 formula) should be monovalent JN.1 vaccines. Based on the further evolution of SARS-CoV-2 and a rise in cases of COVID-19, the agency subsequently determined and advised manufacturers that the preferred JN.1-lineage for the COVID-19 vaccines (2024-2025 formula) is the KP.2 strain, if feasible.

“Vaccination continues to be the cornerstone of COVID-19 prevention,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. “These updated vaccines meet the agency’s rigorous, scientific standards for safety, effectiveness, and manufacturing quality. Given waning immunity of the population from previous exposure to the virus and from prior vaccination, we strongly encourage those who are eligible to consider receiving an updated COVID-19 vaccine to provide better protection against currently circulating variants.”

The updated mRNA COVID-19 vaccines include Comirnaty and Spikevax, both of which are approved for individuals 12 years of age and older, and the Moderna COVID-19 Vaccine and Pfizer-BioNTech COVID-19 Vaccine, both of which are authorized for emergency use for individuals 6 months through 11 years of age.

What You Need to Know

• Unvaccinated individuals 6 months through 4 years of age are eligible to receive three doses of the updated, authorized Pfizer-BioNTech COVID-19 Vaccine or two doses of the updated, authorized Moderna COVID-19 Vaccine.
• Individuals 6 months through 4 years of age who have previously been vaccinated against COVID-19 are eligible to receive one or two doses of the updated, authorized Moderna or Pfizer-BioNTech COVID-19 vaccines (timing and number of doses to administer depends on the previous COVID-19 vaccine received).
• Individuals 5 years through 11 years of age regardless of previous vaccination are eligible to receive a single dose of the updated, authorized Moderna or Pfizer-BioNTech COVID-19 vaccines; if previously vaccinated, the dose is administered at least 2 months after the last dose of any COVID-19 vaccine.
• Individuals 12 years of age and older are eligible to receive a single dose of the updated, approved Comirnaty or the updated, approved Spikevax; if previously vaccinated, the dose is administered at least 2 months since the last dose of any COVID-19 vaccine.
• Additional doses are authorized for certain immunocompromised individuals ages 6 months through 11 years of age as described in the Moderna COVID-19 Vaccine and Pfizer-BioNTech COVID-19 Vaccine fact sheets.

Individuals who receive an updated mRNA COVID-19 vaccine may experience similar side effects as those reported by individuals who previously received mRNA COVID-19 vaccines and as described in the respective prescribing information or fact sheets. The updated vaccines are expected to provide protection against COVID-19 caused by the currently circulating variants. Barring the emergence of a markedly more infectious variant of SARS-CoV-2, the FDA anticipates that the composition of COVID-19 vaccines will need to be assessed annually, as occurs for seasonal influenza vaccines.

For today’s approvals and authorizations of the mRNA COVID-19 vaccines, the FDA assessed manufacturing and nonclinical data to support the change to include the 2024-2025 formula in the mRNA COVID-19 vaccines. The updated mRNA vaccines are manufactured using a similar process as previous formulas of these vaccines. The mRNA COVID-19 vaccines have been administered to hundreds of millions of people in the U.S., and the benefits of these vaccines continue to outweigh their risks.

On an ongoing basis, the FDA will review any additional COVID-19 vaccine applications submitted to the agency and take appropriate regulatory action.

The approval of Comirnaty (COVID-19 Vaccine, mRNA) (2024-2025 Formula) was granted to BioNTech Manufacturing GmbH. The EUA amendment for the Pfizer-BioNTech COVID-19 Vaccine (2024-2025 Formula) was issued to Pfizer Inc.

The approval of Spikevax (COVID-19 Vaccine, mRNA) (2024-2025 Formula) was granted to ModernaTX Inc. and the EUA amendment for the Moderna COVID-19 Vaccine (2024-2025 Formula) was issued to ModernaTX Inc.

Related Information

• Comirnaty (COVID-19 Vaccine, mRNA) (2024-2025 Formula)
• Spikevax (COVID-19 Vaccine, mRNA) (2024-2025 Formula)
• Moderna COVID-19 Vaccine (2024-2025 Formula)
• Pfizer-BioNTech COVID-19 Vaccine (2024-2025 Formula)
• FDA Resources for the Fall Respiratory Illness Season
• Updated COVID-19 Vaccines for Use in the United States Beginning in Fall 2024
• June 5, 2024, Meeting of the Vaccines and Related Biological Products Advisory Committee

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, radiation-emitting electronic products, and for regulating tobacco products.

• Emergency Medicine

Explore the latest in emergency medicine, including prehospital care, resuscitation, trauma, respiratory failure, arrhythmias, and more.

Publication

Article type.

This study assesses outcomes of patients with TBI transferred to the American College of Surgeons level I or level II trauma centers on a nationwide scale.

This cross-sectional study investigates the association of race and ethnicity with rates of diagnostic testing among patients in acute care.

This cohort study examines the outcomes associated with surgical and nonsurgical treatment strategies for uncomplicated appendicitis in older adults with frailty.

This Viewpoint discusses how recognizing systemic racism in emergency departments will allow for the mitigation of racial and ethnic disparities and promote equitable treatment for all patients.

This cross-sectional study examines the longitudinal trends in endotracheal intubation and supraglottic airway utilization for airway management in a national emergency medical services cohort.

This cohort study investigates the association of a high fresh frozen plasma to red blood cell ratio with survival outcomes in patients with severe blunt trauma.

• Naloxone in Out-of-Hospital Cardiac Arrest—More Than Just Opioid Reversal JAMA Network Open Opinion August 20, 2024 Cardiology Resuscitation Substance Use and Addiction Medicine Opioids Full Text | pdf link PDF open access

This cohort study evaluates the association of naloxone administration with clinical outcomes in patients with out-of-hospital cardiac arrests in California.

This cohort study describes the rate of emergency department (ED) encounters, reasons for these visits, and characteristics of the children and adolescents who seek this care.

• Incorporating the Emergency Department in the Blueprint for Youth Suicide Prevention JAMA Network Open Opinion August 15, 2024 Pediatrics Child Injury Prevention Psychiatry and Behavioral Health Suicide Child and Adolescent Psychiatry Full Text | pdf link PDF open access
• Accuracy, Consistency, and Hallucination of Large Language Models When Analyzing Unstructured Clinical Notes in Electronic Medical Records JAMA Network Open Opinion August 13, 2024 Traumatic Brain Injury Neurology Sports Medicine Trauma and Injury Artificial Intelligence Full Text | pdf link PDF open access
• Exploration of Electronic Health Record Patterns of Emergency Physicians—Charting the Digital Burden JAMA Network Open Opinion August 13, 2024 Health Care Quality Health Policy Electronic Health Records Full Text | pdf link PDF open access

This cross-sectional study assesses the associations between patient and clinical factors and variations in time emergency department physicians spend using electronic health record (EHR) systems.

This cohort study estimates the incidence of acute kidney injury (AKI) in patients hospitalized with exertional rhabdomyolysis and identifies factors associated with development of AKI in this population.

This cross-sectional study investigates whether an artificial intelligence (AI) large language model can accurately and reliably analyze clinical narratives and identify helmet use status of patients injured in accidents involving e-bikes, bicycles, hoverboards, and powered scooters.

• Prioritizing Pediatric Emergency Triage—Sorting Out the Challenges JAMA Pediatrics Opinion August 12, 2024 Pediatrics Full Text | pdf link PDF

This cohort study examines data for more than 1 million emergency department visits to gauge the accuracy of version 4 of the Emergency Severity Index in the triage of pediatric patients and consider the characteristics associated with mistriage.

This Medical News story discusses the rise in ransomware cyberattacks on health care, as well as new cybersecurity initiatives.

• Acute Myocardial Infarction Admissions During the COVID-19 Peak JAMA Cardiology Opinion July 31, 2024 Coronavirus (COVID-19) Ischemic Heart Disease Acute Coronary Syndromes Cardiology Full Text | pdf link PDF

This cross-sectional study explores factors underlying the changing incidence in hospital encounters for acute myocardial infarction during the COVID-19 pandemic.

Select Your Interests

Customize your JAMA Network experience by selecting one or more topics from the list below.

• Academic Medicine
• Acid Base, Electrolytes, Fluids
• Allergy and Clinical Immunology
• American Indian or Alaska Natives
• Anesthesiology
• Anticoagulation
• Art and Images in Psychiatry
• Artificial Intelligence
• Assisted Reproduction
• Bleeding and Transfusion
• Caring for the Critically Ill Patient
• Challenges in Clinical Electrocardiography
• Climate and Health
• Climate Change
• Clinical Challenge
• Clinical Decision Support
• Clinical Implications of Basic Neuroscience
• Clinical Pharmacy and Pharmacology
• Complementary and Alternative Medicine
• Consensus Statements
• Coronavirus (COVID-19)
• Critical Care Medicine
• Cultural Competency
• Dental Medicine
• Dermatology
• Diabetes and Endocrinology
• Diagnostic Test Interpretation
• Drug Development
• Electronic Health Records
• End of Life, Hospice, Palliative Care
• Environmental Health
• Equity, Diversity, and Inclusion
• Facial Plastic Surgery
• Gastroenterology and Hepatology
• Genetics and Genomics
• Genomics and Precision Health
• Global Health
• Guide to Statistics and Methods
• Hair Disorders
• Health Care Delivery Models
• Health Care Economics, Insurance, Payment
• Health Care Quality
• Health Care Reform
• Health Care Safety
• Health Care Workforce
• Health Disparities
• Health Inequities
• Health Policy
• Health Systems Science
• History of Medicine
• Hypertension
• Images in Neurology
• Implementation Science
• Infectious Diseases
• Innovations in Health Care Delivery
• JAMA Infographic
• Law and Medicine
• Leading Change
• Less is More
• LGBTQIA Medicine
• Lifestyle Behaviors
• Medical Coding
• Medical Devices and Equipment
• Medical Education
• Medical Education and Training
• Medical Journals and Publishing
• Mobile Health and Telemedicine
• Narrative Medicine
• Neuroscience and Psychiatry
• Notable Notes
• Nutrition, Obesity, Exercise
• Obstetrics and Gynecology
• Occupational Health
• Ophthalmology
• Orthopedics
• Otolaryngology
• Pain Medicine
• Palliative Care
• Pathology and Laboratory Medicine
• Patient Care
• Patient Information
• Performance Improvement
• Performance Measures
• Perioperative Care and Consultation
• Pharmacoeconomics
• Pharmacoepidemiology
• Pharmacogenetics
• Pharmacy and Clinical Pharmacology
• Physical Medicine and Rehabilitation
• Physical Therapy
• Physician Leadership
• Population Health
• Primary Care
• Professional Well-being
• Professionalism
• Psychiatry and Behavioral Health
• Public Health
• Pulmonary Medicine
• Regulatory Agencies
• Reproductive Health
• Research, Methods, Statistics
• Resuscitation
• Rheumatology
• Risk Management
• Scientific Discovery and the Future of Medicine
• Shared Decision Making and Communication
• Sleep Medicine
• Sports Medicine
• Stem Cell Transplantation
• Substance Use and Addiction Medicine
• Surgical Innovation
• Surgical Pearls
• Teachable Moment
• Technology and Finance
• The Art of JAMA
• The Arts and Medicine
• The Rational Clinical Examination
• Tobacco and e-Cigarettes
• Translational Medicine
• Trauma and Injury
• Treatment Adherence
• Ultrasonography
• Users' Guide to the Medical Literature
• Vaccination
• Venous Thromboembolism
• Veterans Health
• Women's Health
• Workflow and Process
• Wound Care, Infection, Healing
• Register for email alerts with links to free full-text articles
• Access PDFs of free articles
• Manage your interests
• Save searches and receive search alerts

• EMResident Archives
• Publications
• Submit an Article

• Critical Care
• Health Policy Journal Club
• Program Director Interviews

2020-2021: 21 Greatest Hits - Emergency Medicine Research Edition

It is often difficult to keep up with all of the highest impact papers in emergency medicine..

The EMRA Research Committee has compiled a quick review of some of the most practice-affirming or practice-changing papers published from September 2020 to September 2021. This is by no means a definitive list, but all of these papers will likely be good to know for your next shift!

THERAPEUTICS

A Randomized Trial Comparing the Efficacy of Five Oral Analgesics for Treatment of Acute Musculoskeletal Extremity Pain in the Emergency Department This randomized control trial compared the efficacy of 5 oral analgesics for the treatment of acute musculoskeletal extremity pain. All patients were deemed to need an x-ray and be appropriate for oral pain control by the treating physician. In the end, no particular analgesic was more efficacious at 1 or 2 hours. However, there was significantly more nausea and vomiting among patients treated with opioids.

Regimens included:

• 400 mg ibuprofen and 1,000 mg acetaminophen
• 800 mg ibuprofen and 1,000 mg acetaminophen
• 30 mg codeine and 300 mg acetaminophen
• 5 mg hydrocodone and 300 mg acetaminophen
• 5 mg oxycodone and 325 mg acetaminophen

The Use of Tranexamic Acid to Reduce the Need for Nasal Packing in Epistaxis (NoPAC): Randomized Controlled Trial The largest RCT of TXA in epistaxis (496 participants) demonstrates that TXA does not provide improved benefit compared to traditional nasal packing at reducing the need for anterior nasal packing (43.7% of the experimental group still required anterior nasal packing to achieve tamponade). Limitations of the study include the studied population (primarily older men on anticoagulation), and the dose of TXA used.

Regional anesthesia on the finger: traditional dorsal digital nerve block versus subcutaneous volar nerve block, a randomized controlled trial A prospective, multicenter, RCT of 409 ED patients compared the subcutaneous volar nerve block vs. the traditional dorsal digital nerve block. All patients had a finger injury requiring regional anesthesia for surgical treatment. Results demonstrated that numbing the thumb via a dorsal block is preferred, whereas individual fingers achieve better dorsal analgesia via the dorsal block and better analgesia on the proximal phalanx via a volar block. Overall, the dorsal nerve block gave greater anesthesia but required 2 injections and a greater amount of lidocaine.

Isopropyl alcohol nasal inhalation for nausea in the triage of an adult emergency department A randomized, double-blind, placebo-controlled trial assessed the efficacy of isopropyl alcohol (IPA) to patients who presented to triage in the ED with the chief complaint of isolated nausea and vomiting. Patients scored 3 or higher on the nausea/vomiting numerical rating scale. Among 118 patients, 62 patients who received IPA reported improved nausea and vomiting-related symptoms vs. placebo and required less rescue treatment. This is the third RCT demonstrating the efficacy of inhaled IPA for the acute treatment of uncomplicated nausea and vomiting.

GASTROENTEROLOGY

A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis A non-blinded, pragmatic non-inferiority randomized trial of 1,552 patients with appendicitis compared quality of life at 30 days between patients treated with 10 days of antibiotics vs. appendectomy for appendicitis. The results demonstrated that antibiotics have comparable outcomes to surgery for acute appendicitis etiologies, with the exception of patients with an appendicolith who had higher rates of complications in the antibiotic group.

Prospective Validation of Canadian TIA Score and Comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischemic attack: multicenter prospective cohort study This prospective multicenter cohort study was designed to validate the Canadian TIA Score for patients needing risk stratification for future adverse neurologic events. Results demonstrated that among the 7,607 ED patients presenting for TIA, 1.4% had a subsequent stroke within 7 days, and 1.1% required carotid endarterectomy/stenting. The Canadian TIA score outperformed the ABCD2 and ABCD2I in risk stratifying patients with an improved area under the curve. The Canadian TIA risk score was also able to identify a low-risk cohort appropriate for rapid outpatient evaluation. The Canadian TIA score is now validated and can be used in clinical practice.

MAGraine: Magnesium compared to conventional therapy for treatment of migraines The single-center, prospective, double-blinded, randomized, three-armed trial compared magnesium, metoclopramide, and prochlorperazine for the treatment of migraine. This study found that magnesium was not inferior in efficacy to the other two medications, which can be especially useful in patients who simultaneously present with prolonged QT. However, patients who received magnesium for migraine management were more likely to require additional analgesia subsequently. One significant limitation of this study is that it was stopped early due to COVID, causing it to be underpowered, with n = 157.

Effect of a Restrictive vs Liberal Blood Transfusion Strategy on Major Cardiovascular Events Among Patients With Acute Myocardial Infarction and Anemia: The REALITY Randomized Clinical Trial An open-label, noninferiority, randomized trial attempted to identify an optimal transfusion strategy in patients with acute myocardial infarction and anemia. Primary outcome was major 30-day adverse cardiovascular events. The study concluded that among the 668 participants, between the restrictive (transfuse at HgB ≤ 8) and liberal transfusion groups (transfuse at HgB ≤ 10), major adverse cardiac events occurred in 11.0% of patients in the restrictive group vs. 14.0% in the liberal transfusion group. The authors concluded that a restrictive transfusion resulted in a noninferior rate of MACE after 30 days with a relative risk of 0.79 (1-sided 97.5% CI, 0.00-1.19). They also cautioned that the non-inferiority confidence interval was large enough to contain worse outcomes in the restrictive group, warranting a larger study to confirm these results.

  DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction (DIFOCCULT Study) This is a retrospective case-control study evaluating the performance of EKG STEMI criteria or expanded EKG Acute Coronary Occlusion Myocardial Infarction(ACOMI) criteria for the identification of Acute Coronary Occlusion. In this study, 1,152 STEMI and 2,353 non-STEMI patients were evaluated. In the non-STEMI group 28% were found to have an acute coronary occlusion identifiable on EKG with ACOMI criteria. These non-STEMI patients with ACOMI had similar mortality rates to STEMI patients. The author shows that a refined EKG paradigm for the identification of acute coronary occlusion would have improved sensitivity to identify those who need acute reperfusion therapy.

Effects of Fluoroquinolones on Outcomes of Patients With Aortic Dissection or Aneurysm This was a retrospective cohort study that compared patients who were diagnosed with aortic aneurysms or aortic dissections and their mortality risk after fluoroquinolone exposure. Patients were identified after their initial hospitalization and then outpatient data was followed, looking at prescription days of fluoroquinolones (experimental group) or amoxicillin (negative control group) and then monitored for adverse outcomes. The study concluded that exposure to fluoroquinolones was associated with a higher risk of all-cause death (adjusted hazard ratio [aHR]: 1.61; 95% confidence interval [CI]: 1.50 to 1.73) as well as aortic-related death (aHR: 1.80; 95% CI: 1.50 to 2.15). Increasing evidence has shown fluoroquinolones should be avoided in high-risk patients unless no other treatment options are available.

CRITICAL CARE

The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department The single-center, prospective cohort study assessed the prevalence of awareness with paralysis in ED patients receiving mechanical ventilation. In this study, 383 patients were surveyed following extubation for awareness during paralysis. The study identified a prevalence of 2.6% (10/383), with rocuronium usage at any point resulting in higher instances of awareness (70%) vs. all other paralytics (31.4) (95% confidence interval 0.94 to 8.8). While there are many possible reasons for this prevalence, it is much higher than the rate observed in general anesthesia (~1%), and care should be taken to start appropriate and timely post-intubation sedation.

Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest This is an open-label randomized control trial of 1,850 adults with an out-of-hospital cardiac arrest who subsequently underwent targeted hypothermia (at 33°C), or targeted normothermia. Primary outcome was mortality at 6 months. Functional outcomes at 6 months were also evaluated. The study concluded 50% of the patients treated with hypothermia died, compared to 48% of the normothermic group (relative risk with hypothermia, 1.04; 95% confidence interval [CI], 0.94 to 1.14; P = 0.37). Similarly, 55% of patients in the hypothermic group suffered from severe disability (modified Rankin scale score ≥4), compared to 55% of normothermic patients (relative risk with hypothermia, 1.00; 95% CI, 0.92 to 1.09), thus concluding that targeted hypothermia does not decrease mortality within 6 months when compared to targeted normothermia. This study should be narrowly interpreted, as it is a highly selected patient population that does not compare well to the general U.S. cardiac arrest population in regard to rates of bystander CPR, rates of presenting with a shockable rhythm, and neurologically intact survival rates.

Lung-Protective Ventilation and Associated Outcomes and Costs Among Patients Receiving Invasive Mechanical Ventilation in the ED A retrospective study assessed how ventilation settings in the ED affected ICU outcomes among 4,174 patients. In this study, 58.4% of patients on ventilation received lung-protective ventilation in the ED (defined as tidal volume ≤ 8mL/kg predicted body weight) and were less likely to suffer from ARDS (aOR, 0.87; 95% CI, 0.81-0.92) or in-hospital death (aOR, 0.91; 95% CI, 0.84-0.96). ED ventilatory care of critically ill patients can have lasting effects on mortality and other adverse outcomes.

Early head-to-pelvis computed tomography in out-of-hospital circulatory arrest without obvious etiology In patients who present following an out-of-hospital cardiac arrest, identifying obvious causes can be challenging and not immediately identifiable. A prospective, observational pilot study assessed the safety and efficacy of early head-to-pelvis CT imaging to identify the cause of cardiac arrest. Among 104 patients a sudden death CT scan (SDCT) protocol (non-contrast CT head, ECG-gated cardiac and thoracic CT angiogram, and nongated venous-phase abdominopelvic CT angiogram) identify the cause of cardiac arrest in nearly 39% of patients. In addition, life-threatening complications of resuscitation were identified in 16% of patients. Though exploratory, these findings suggest that a sudden death CT protocol can expedite the diagnosis of potential causes and identify resuscitation complications in patients with out-of-hospital cardiac arrests.

Noninvasive Ventilation Use in Critically Ill Patients with Acute Asthma Exacerbation A retrospective cohort study assessed the association between noninvasive ventilation and a subsequent need for invasive mechanical ventilation and in-hospital mortality among patients admitted to the ICU with an asthma exacerbation. Noninvasive ventilation was associated with a lower likelihood of receiving invasive mechanical ventilation (adjusted generalized estimating equation odds ratio, 0.36; 95% CI, 0.32-0.40) and decreased in-hospital mortality (odds ratio, 0.48; 95% CI 0.40-0.58) unless patients had concomitant comorbid pneumonia and/or severe sepsis.

Short-Course Antimicrobial Therapy for Pediatric Community-Acquired Pneumonia: The SAFER Randomized Clinical Trial A multicenter, blinded, non-inferiority RCT compared rates of cure for community-acquired pneumonia with a short course (5 days) vs. standard course (10 days) of amoxicillin. In this study, 281 pediatric ED patients between 6 months and 10 years old with CAP who were being discharged were randomized. The results demonstrated that the short course of antibiotic therapy was comparable to longer course antibiotics. Clinical cure occurred in 88.6% in the short group and 90.8% in the control group (risk difference, -0.016; 97.5% confidence limit, -0.087). In pediatric patients who are otherwise healthy presenting with community-acquired pneumonia, it is reasonable to consider a shorter course (< 10 days) of antibiotics and follow-up with primary care physician to ensure clinical cure. Though these results are consistent with other trials, the results themselves are not as robust, and an additional trial is likely needed with different endpoints to confirm these findings.

Risk Factors and Outcomes After a Brief Resolved Unexplained Event: A Multicenter Study To evaluate whether current American Academy of Pediatrics risk criteria predict BRUE outcomes, a multicenter retrospective cohort study assessed more than 2,000 infants less than 1 year of age who presented with a suspected BRUE without a probable alternative or definite diagnosis. Among these patients, 87% met AAP higher-risk criteria for having at least 1 AAP risk factor; 63% were hospitalized, with the most common explanations being less serious such as GERD (18.5%), choking or gagging (8.2%), viral respiratory infections (4.4%), and breath-holding spells (4.1%). A serious diagnosis was identified in 4.0% of patients, with 45% of these diagnoses being made after discharge from the index visit without an explanation. Having at least 1 AAP risk factor (ie, higher-risk criteria) was associated with a recurrent event in the ED or hospital (odds ratio [OR] 5.9; 95% confidence interval [CI] 2.7–12.6) and a recurrent event that led to an explanation (OR 15.1; 95% CI 2.1–108.6). The results suggest that while the absence of AAP high-risk criteria had a robust NPV (97%) for underlying serious conditions, the presence of criteria did not have a strong PPV (4%).

Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old This paper represents the first official guidelines from the American Academy of Pediatrics for the evaluation of well-appearing febrile(≥ 38°C) infants 8-60 days old. These landmark guidelines are divided into three algorithms for infants 8-21 days of age, 22-28 days of age, and 29-60 days of age. There is an abundance of information in this paper and it is worth becoming familiar with and having handy for when this situation arises. Importantly, there are inclusion and exclusion criteria listed to ensure kids are appropriate for utilization of these guidelines.

PRE-HOSPITAL

Tranexamic Acid During Prehospital Transport in Patients at Risk for Hemorrhage After Injury: A Double-blind, Placebo-Controlled, Randomized Clinical Trial Pragmatic, phase 3, multicenter, double-blind, placebo-controlled, superiority randomized trial which assessed clinical outcomes among 6559 patients at risk for hemorrhage who received prehospital tranexamic acid (single dose). The 30-day all-cause mortality was assessed among patients who received 1g TXA (treatment) or 100 mL saline (placebo) prior to hospitalization. Results showed 30-day mortality among patients receiving TXA was 8.1% vs. placebo 9.9% (95% CI, -5.6% to 1.9%; P = .17). Post-hoc analysis, stratified by time to TXA administration, showed giving TXA within 1 hour of injury in patients with severe shock lowers 30-day mortality compared with placebo (18.5% vs 35.5%; difference, -17%; 95% CI, -25.8% to -8.1%; P < .003).  

Diagnostic Accuracy of Lung Point-Of-Care Ultrasonography for Acute Heart Failure Compared with Chest X-ray Study Among Dyspneic Older Patients in the Emergency Department A retrospective cohort study assessed whether POCUS was comparable to chest x-ray in identifying acute heart failure exacerbation among older patients. An 8-zone lung ultrasound protocol was used to look for signs of pulmonary edema; 148 patients were enrolled. For the diagnosis of acute heart failure, POCUS had a sensitivity of 92.5% and a specificity of 85.7% vs. chest x-ray with a sensitivity of 63.6% and specificity of 92.9%. Overall, POCUS had a significantly higher sensitivity for the diagnosis of acute heart failure, while demonstrating comparable specificity.

Impact of point-of-care ultrasound on treatment time for ectopic pregnancy A retrospective, observational, cohort study assessed whether transabdominal POCUS by itself or in addition to consultative radiology ultrasound (RADUS), reduces ED treatment time for patients with ectopic pregnancy requiring operative care. Among 109 patients admitted with ectopic pregnancies, 36 received POCUS (with 23 of those 36 also receiving RADUS), and 73 received RADUS only. POCUS involved the RUPTURE exam (Right Upper and Pelvis Timley Ultrasound for Ruptured Ectopic) to evaluate for an intrauterine pregnancy and abdominal free fluid. The average ED treatment time in the POCUS group was 157.9 min vs. 206.3 min in the RADUS group (p = 0.0141). The median time to OR for ruptured ectopic pregnancies was 203.0 min (interquartile range [IQR] 159.0) in the POCUS group versus 293.0 min (IQR 139.0) in the RADUS group (p = 0.0002). These results conclude that POCUS was associated with significantly faster time to OR for ectopic pregnancies.

Related Articles

Rapid research review: power, rapid research review: more study types, all articles.

• Administration and Operations Committee 2
• Critical Care Committee 4
• Education Committee 10
• Government Services 4
• Health Policy Committee 8
• Informatics Committee 3
• Medical Student Council 7
• Pediatrics Committee 4
• Research Committee 6
• Simulation Committee 3
• Social EM Committee 7
• Wilderness Committee 5
• International Committee 8
• Prehospital and Disaster Medicine Committee 5
• Simulation Division 2
• Sports Medicine Committee 5
• Advancement of EM 108
• Administration & Operations 55
• Admin Ops Literature Review 8
• Diversity and Inclusion 18
• Research 31
• Rapid Research Review 9
• Attending 2
• Award Winners 20
• Educational Courses 2
• Residency Leadership 2
• Travel Scholarships 3
• ACEP Member Benefits 2
• Career Planning 78
• Board Certification 7
• Interviewing 5
• Job Search 3
• Practice Environments 25
• Community 2
• International 10
• Locum Tenens 2
• Clinical 976
• Addiction Medicine 4
• Surgical Airway 1
• Behavioral Health 5
• Cardiology 153
• ECG Challenge 47
• Consult Corner 5
• Critical Care 227
• Critical Care Alert 103
• Critical Care Devices 11
• Critical Care Roadblock 3
• Critical Care Ultrasound 14
• Deep Dive in CritCare 9
• Ventilator Management 6
• Dermatology 8
• Disaster Medicine 12
• Prehospital Care 21
• Endocrinology 11
• Event Medicine 2
• Gastroenterology 15
• Geriatrics 4
• Hematology 19
• Immunology 1
• Infectious Disease 131
• COVID-19 80
• Informatics 18
• Telemedicine 3
• International EM 25
• Nephrology 14
• Neurology 50
• Ophthalmology 15
• Orthopedics 26
• Osteopathic 3
• Pain Management 24
• Palliative Care 14
• Patient Interactions 18
• Pediatric EM 99
• Psychiatry 8
• Mental Health 3
• Pulmonary 17
• Radiology 7
• Rheumatology 1
• Simulation 13
• Social EM 52
• Space Medicine 3
• Sports Medicine 11
• Toxicology 98
• Medications 12
• Recreational Drugs 10
• Penetrating 1
• Traumatic Brain Injury 2
• Ultrasound 84
• Guided Procedures 5
• POCUS For the Win 7
• Undersea and Hyperbaric 2
• Visual Diagnosis 20
• Wilderness Medicine 25
• Editorial 129
• Editor's Forum 54
• Heart of EM 12
• Opinion-Editorial 13
• Leadership Reports 77
• ACEP Representative 2
• ACGME RC-EM 11
• President's Message 48
• Speaker Report 8
• Treasurer's Report 3
• Membership 3
• Events & Activities 21
• ACEP Scientific Assembly 6
• CORD Academic Assembly 2
• EM Wellness Week 1
• EMRA MedWAR 3
• Leadership and Advocacy Conference 6
• Fellowships 12
• Education Fellowships 2
• Global EM Fellowships 2
• Health Policy Fellowships 1
• Pediatric Fellowships 2
• Health Equity 3
• Health Policy 144
• Advocacy 45
• Affordable Care Act 7
• Health Policy Journal Club 76
• Legislation 9
• Regulatory 2
• Leadership 181
• Committees and Divisions 4
• EMRA Board of Directors 40
• EMRA Spotlight 127
• Representative Council 9
• Medical Education 80
• Board Review 2
• Questions 1
• Med Ed Fellowship Director Interview Series 10
• Medical Students 199
• Advising 60
• Away Rotations 8
• Dual Degree Programs 1
• ERAS & Residency Application 3
• Military Advising 2
• Program Director Interviews 83
• Rank List 1
• Residents Program Interviews 4
• Medical Student Council 29
• Mentorship 4
• Non Clinical 64
• Health Care Administration 35
• Otolaryngology 5
• Resuscitation 5
• Wellness 130
• Compassion Fatigue 9
• Financial 10
• Insurance 2
• Loan Refinancing 2
• Personal Finance 4
• Medico Legal 32
• Medical Liability 2
• Risk Management Pitfalls 23
• Personal 14
• Workplace 21
• Med Student 46
• Advertise with us
• Submit an article
• Connect with us

© 2021 Emergency Medicine Residents' Association | Privacy Policy | Website Links Policy | Social Media Policy

• Journal of Emergency Medicine
• Recommended Events
• About Joint CME Providership with AAEM
• AAEM CME Online
• AAEM25 Scientific Program
• Speaker Development Group
• Claim CME for AAEM24
• Become an Examiner
• ED Operations Certificate Course (EDOCC)
• Claim CME for MEMC23
• Written Board Review Course
• Leadership Academy
• Claim CME for Past Events
• Common Sense Submissions
• Common Sense Advertising
• Western Journal of Emergency Medicine
• Insights Advertising
• AAEM Book Store
• Connect With Peers (MyAAEM)
• Chapter Divisions
• Interest Groups
• Join or Renew
• Group Membership
• Refer a Colleague to AAEM
• AAEM Merchandise
• Envision Lawsuit
• Press Coverage
• Support Lawsuit
• AAEM Past Presidents
• Residency Visits
• Award Recipients
• Code of Ethics
• AAEM Foundation
• AAEM LEAD-EM
• Collaborating Organizations

The  Journal of Emergency Medicine ( JEM ) is the official journal of the American Academy of Emergency Medicine (AAEM).  JEM  is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM features research papers, clinical studies, and articles that emphasize the education of emergency physicians and the practice of emergency medicine. AAEM actively encourages its members to contribute editorial material for publication in  JEM . As AAEM’s official journal, an online subscription to  JEM  is included in the membership dues of each member.*

The AAEM membership list is private, however, in order to receive this member benefit, your name and address are provided to Elsevier, the publisher of the JEM . If you would prefer not to receive this member benefit, please email us at  [email protected] .

* Note: There is no discount on your membership dues should you decide to opt out of this member benefit.

The Journal of Emergency Medicine Audio Summary

Monthly audio podcast summary of important articles from the Journal of Emergency Medicine, the official journal of AAEM, and discussion of emergency medicine board review topics.

International Journal of Emergency Medicine

Call for papers "enhancing stroke care worldwide: identifying barriers and bridging gaps for improved prognosis".

Trending Articles

Have a look at the IJEM mentions through social media in the past month & discover the most trending articles

• Most accessed

Rupture of a calcified right ventricle to pulmonary artery homograft by balloon dilation– emergency rescue by venus P-Valve

Authors: Hojjat Mortezaeian, Ata Firouzi, Pouya Ebrahimi, Mohsen Anafje, Peyman Bashghareh, Phuoc Doung and Shakeel Qureshi

U-shaped correlation of lymphocyte count with all-cause hospital mortality in sepsis and septic shock patients: a MIMIC-IV and eICU-CRD database study

Authors: Guyu Zhang, Tao Wang, Le An, ChenChen Hang, XingSheng Wang, Fei Shao, Rui Shao and Ziren Tang

Diagnostic laparoscopy with indocyanine green fluorescence test for the evaluation of intestinal perfusion in abdominal blunt injury: a case report

Authors: Ze-Rui Li, Yi-Chiao Cheng and Zhi-Jie Hong

Extended reality training for mass casualty incidents: a systematic review on effectiveness and experience of medical first responders

Authors: María del Carmen Cardós-Alonso, Lucía Otero-Varela, María Redondo, Miriam Uzuriaga, Myriam González, Tatiana Vazquez, Alberto Blanco, Salvador Espinosa and Ana María Cintora-Sanz

IFEM model curriculum: emergency medicine learning outcomes for undergraduate medical education

Authors: Arif Alper Cevik, Elif Dilek Cakal, James Kwan, Simon Chu, Sithembile Mtombeni, Venkataraman Anantharaman, Nicholas Jouriles, David Teng Kuan Peng, Andrew Singer, Peter Cameron, James Ducharme, Abraham Wai, David Edwin Manthey, Cherri Hobgood, Terrence Mulligan, Edgardo Menendez…

Most recent articles RSS

View all articles

Physical and mental health impacts of COVID-19 on healthcare workers: a scoping review

Authors: Natasha Shaukat, Daniyal Mansoor Ali and Junaid Razzak

Fluid resuscitation in trauma: what are the best strategies and fluids?

Authors: G. H. Ramesh, J. C. Uma and Sheerin Farhath

Intractable nausea and vomiting in naïve ingestion of kratom for analgesia

Authors: Vir Singh, Nadir Mulla, James Link Wilson, Aaron Umansky, Jenny Lee, Trilok Stead and Latha Ganti

Disaster management of the psychological impact of the COVID-19 pandemic

Authors: Mohamud Sheek-Hussein, Fikri M. Abu-Zidan and Emmanuel Stip

Tenecteplase vs. alteplase for acute ischemic stroke: a systematic review

Authors: Neha Potla and Latha Ganti

Most accessed articles RSS

State of International Emergency Medicine

Practice Innovations in Emergency Medicine

Educational Advances in Emergency Medicine

• Editorial Board
• Manuscript editing services
• Instructions for Editors
• Sign up for article alerts and news from this journal
• Follow us on Twitter

Annual Journal Metrics

Citation Impact 2023 Journal Impact Factor: 2.0 5-year Journal Impact Factor: 2.3 Source Normalized Impact per Paper (SNIP): 1.157 SCImago Journal Rank (SJR): 0.700 Speed 2023 Submission to first editorial decision (median days): 27 Submission to acceptance (median days): 134 Usage 2023 Downloads: 985,950 Altmetric mentions: 682

• More about our metrics
• ISSN: 1865-1380 (electronic)
• ISSN: 1865-1372 (print)

ISSN: 1865-1380

• General enquiries: [email protected]

• Subscribe to journal Subscribe
• Get new issue alerts Get alerts

Secondary Logo

Journal logo.

Colleague's E-mail is Invalid

Your message has been successfully sent to your colleague.

Save my selection

Emergency medicine: past, present, and future challenges

Wei, Shujian a,b,c,d,e,∗

a Department of Emergency Medicine and Chest Pain Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China

b Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China

c Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China

d Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China

e Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.

∗Corresponding author. Address: Department of Emergency Medicine and Chest Pain Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 107, Wenhuaxi Road, Jinan, Shandong, 250012, China. E-mail address: [email protected] (S. Wei).

How to cite this article: Wei S. Emergency medicine: past, present, and future challenges. Emerg Crit Care Med. 2021;1:49–52. doi: 10.1097/EC9.0000000000000017

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

Origin and history of emergency medicine

The term “emergency,” first used in the 1630s, is derived from the Latin word emergere , meaning unforeseen events that require immediate attention. The term “emergency medicine” can be traced to the French Revolution (1789–1799). In 1792, Dominique Jean Larrey, a military medical surgeon, gained a position in the Army of the Rhine and left for Strasbourg, where he witnessed great mobility of the horse artillery and then suggested that General Adam Philippe de Custine have the medical staff use this method to speed up transport of the wounded. The general approved Larrey's proposal. Larrey's “ambulance” was a simple carriage, despite the exposure to enemy fire. In 1797, during the first Italian campaign, Larrey created a complete rescue system with an active medical team in the battlefield. In contrast to previous rescue methods, Larrey transported critically wounded patients to the rescue station and operated on them as soon as possible, instead of delaying the operation after the battle. The timely rescue system created by him enabled every wounded soldier to be treated within 24 hours, which significantly reduced the mortality rate. Therefore, Larrey has often been referred to as “the father of emergency medical services.” [1]

Medicine, as a professional field, dates back to the early 19th century, while emergency medicine can only be traced back to 50 years ago, making it the most recently developed major field in medicine. Before the 1960s, staff in hospital emergency departments usually worked in rotation with family doctors, general surgeons, physicians, and other specialists. In many small emergency departments, nurses conducted the triage of patients, and specialty doctors were called in based on the type of injury or disease. Many pioneers of emergency medicine were family doctors and other specialists, who believed that extra training in first aid was necessary. A group of doctors left their professional positions and devoted themselves to education. In 1952, Maurice Ellis was appointed as the first “first aid consultant” at Leeds General Infirmary in England. In 1967, the Casualty Surgeons Association was founded, with Maurice Ellis as its president. [2,3] In 1961, in the United States, Dr James DeWitt Mills, along with 4 assistant physicians, established 24/7 emergency care at Alexandria Hospital in Alexandria, Virginia; it was later known as the Alexandria Plan. [4] In 1970, the University of Cincinnati launched the first emergency resident physician program in the world. In 1971, the University of Southern California became the first American medical school to establish a department of emergency medicine. [5] History was made in 1979, when the American Board of Medical Specialties voted to make emergency medicine a recognized medical specialty in the United States. [5]

In China, emergency medicine started relatively late. The Ministry of Health issued “Suggestions on Strengthening First Aid Work in the City” and “On the Release of the Construction Plan of Hospital Emergency Departments (Trial)” on October 30, 1980 and June 11, 1984, respectively. These 2 documents stipulated the work direction, scope, and tasks of the emergency department; thereby, laying the foundation for the construction of emergency departments in China. In 1985, Peking Union Medical College Hospital established the first postgraduate program in emergency medicine. [6–8]

Current state of emergency medicine

Emergency medicine mainly involves the rapid assessment, treatment, and triage of critically ill patients, and has transformed from the emergency room to the emergency department or emergency center. Hospitals typically set up a relatively complete emergency medical system of “out-of-hospital emergency medical services, in-hospital emergency medical services, and critical care.” Numerous emergency diagnostic and treatment technologies, such as cardiopulmonary resuscitation, emergency percutaneous coronary intervention, continuous renal replacement therapy, left ventricular assistive devices, and extracorporeal membrane oxygenation, are applied in emergency medicine. Moreover, a growing number of qualified physicians have devoted themselves to emergency medicine, and several academic platforms have been established, which facilitate knowledge exchange.

With the continuous reform of the medical system and the comprehensive implementation and promotion of hierarchical diagnostic and treatment systems from medical reform, the development of emergency medicine is confronted with rare opportunities and more challenges. For example, the construction of emergency systems varies across nations and regions. Practitioners in emergency services have the vital task of establishing a complete emergency diagnosis and treatment system to maintain the daily health of the public and to satisfy the emergency demands of major public health events. It is necessary to move the front of first aid forward, carry out multidisciplinary cooperation, treat all types of critically ill patients, deal with public health emergencies, and boost hierarchical diagnosis and treatment work. Amid the rapid growth of modern medicine, advanced technology and innovative drugs continue to emerge. In many cases of emergency work, it is the timely, orderly, and efficient application of these technologies and drugs to the early treatment of critically ill patients that matters. Therefore, “process optimization and early treatment” is an important direction in emergency medicine research.

With the development of a medical discipline, each medical specialty is more characterized, and even some single diseases tend to form specialties. [9] Following the law of medical development, emergency medicine also gives full play to specialty characteristics and the development of subspecialties. [10] For example, in areas with a high incidence of cardiovascular diseases, emergency centers have subspecialty focus areas for cardiovascular diseases, and in rural areas with a common occurrence of acute poisoning, emergency departments of primary hospitals establish a subspecialty for the treatment of acute poisoning. In developing subspecialties, emergency medicine focuses on the advancement of diagnostic and treatment technologies for life-threatening diseases and integration with other subspecialties. The construction of high-quality subspecialties in emergency medicine is conducive to the development of new diagnostic and treatment equipment and technology.

Future of emergency medicine

The coronavirus disease pandemic has brought huge challenges to medical systems, especially emergency medicine. [11] Elevating the capability of early identification, appropriate treatment, and life support for severe or critical patients will always be the core topics of emergency medicine.

Emergency medicine in the future will be characterized by continuous advances in practices, research, technologies, and so forth. In terms of clinical practices, problems such as inefficiency and crowding may arise and cause tension in emergency departments. The development of emergency medicine is still in its primary stage and is extremely uneven between rural and urban areas. The resolution of such issues and optimization of processes in emergency medicine can be realized by implementing an increasing number of equipment configurations, improving the structure of emergency medical personnel, and establishing a closer linkage between out-of-hospital and in-hospital emergency services. In essence, “process optimization and early treatment” manifests as an influential component in the development of emergency medicine. In the optimization of the emergency process, the stability of emergency medical professionals is a valuable resource. Upgrading clinical emergency care competence, including rapid response, effectiveness, and service attitude, and improving the skills of medical professionals in the emergency department are of great importance.

The demands for technology are certain to direct the course of emergency services, as the need for timely diagnosis and treatment of patients continues to grow. Information technology can be used to tap available resources and collect information on patients and disease management to aid emergency staff in real time via telemedicine. Specifically, in the absence of specialists or general practitioners on site, the vital signs of patients and critical information can be wirelessly transmitted to experts who can provide remote guidance that may be critical to saving lives. [12] In addition, remote monitoring also enables hospitals to grasp the condition of patients at the earliest time, formulate emergency plans in advance, and ensure a seamless connection between out-of-hospital emergency and in-hospital treatment. By virtue of networks, the real-time transmission of medical devices that monitor information, ambulances’ positioning information, and video footage from inside and outside ambulances can facilitate remote consultation and guidance. Moreover, the collection, processing, storage, transmission, and sharing of out-of-hospital emergency information can fully enhance treatment efficiency and service quality, thereby optimizing the process and mode of service.

Big data technology can fully explore medical information to aid in the management and decision-making of emergency care. [13] One of the applications of big data in the medical field is the establishment of a cloud platform for emergency and critical care information management. Such a platform would collect the diagnosis-, examination-, and treatment-related information of patients from databases, such as an emergency logbook, a hospital information system, a picture archiving and communication system, a microbial detection and management system, and a pathology information system. Next, the data were classified, cleaned, extracted, and explored in depth using the platform. Based on this information, a teaching management system can be obtained, including a multidisciplinary triage management system, a critical care score and grading management system, and an early warning system for serious emergencies. The application of big data technology in emergency medicine provides medical practitioners with access to various information databases for each individual and possible treatment options, which will greatly improve teaching efficiency and the ability to diagnose and treat related diseases.

Precision medicine is a medical model that fully considers individual differences in the genes, environment, and lifestyle of patients to achieve the most effective treatment and prevention of diseases. The emergency department is the first critical link in the clinical diagnosis and treatment of critical illnesses and infectious diseases, and individualized accurate assessment and prevention of disease susceptibility is a valuable research direction for precision emergency medicine. [14] Acute infectious diseases are among the most common diseases in the emergency department. However, given the complexity of diseases, lag in detection technology, and lack of multidimensional clinical information integration technology, the diagnosis and treatment of common diseases such as community-acquired pneumonia remain stagnant. In addition, the emergence of drug-resistant pathogens and emerging microorganisms poses a challenge to empirical therapy protocols. Identifying pathogenic microorganisms quickly and accurately is critical for initiating individualized treatment plans and is also the core component of precision emergency medicine systems. The ideal method of monitoring the outbreak of drug-resistant pathogenic microorganisms in communities or hospitals is to analyze the genetic ancestry of pathogenic microorganisms through genome technology. One of the essential tasks of emergency medicine is to use clinical information to provide individualized diagnosis and treatment for cases without a clear etiology. To some extent, it is necessary to establish etiological diagnoses through emergency treatment processes. In addition to molecular etiology diagnoses based on pathogenic specimens (eg, throat swabs, sputum, and body fluids), diagnostic techniques based on omics information have also seen rapid advances, which will improve precision emergency treatment services. For the differential diagnosis of emergency and critical care illnesses, precision emergency medicine can enhance diagnostic effectiveness significantly with the help of multidimensional and omics data, thus creating the ideal conditions for individualized diagnosis and treatment.

With the combination of big data and precision medicine, information technology can promote the growth of scientific research and clinical work in emergency medicine, such as sequencing, information construction, data integration, and analysis, and improve the use of big data in emergency medicine. Under these circumstances, it is possible to achieve breakthroughs in the development of targeted drugs for precision therapy, complete the closed-loop service of precision emergency medicine, and establish a disciplinary system for precision emergency medicine in China.

Artificial intelligence can promote the growth of emergency medicine. [15] Equipped with capabilities in prediction, analysis, and response, artificial intelligence systems can aid emergency staff in diagnosis and treatment. When artificial intelligence tools execute instructions, they can learn from big data through image recognition, speech recognition, human–computer interaction, physical sensing, and other means. After finishing examinations quickly, artificial intelligence tools can formulate a relatively accurate diagnosis and individualized medicine. In addition, artificial intelligence can assist in locating potential risks and threats in advance. In some emergency events, artificial intelligence can assess the situation and predict the required medical services. Another example of artificial intelligence is the use of medical robots. Apart from their application during complex surgeries, medical robots can deliver objects to patients in quarantine and help avoid human contact during virus epidemics. In short, the use of artificial intelligence will undoubtedly benefit emergency medicine in the future.

As more countries are improving their emergency medical systems, the global scale of information exchange is empowering international emergency medicine. Promoting the quality of academic exchange among countries is a priority in the development of international emergency medicine. Moreover, the variety and complexity of emergency diseases pose challenges to timely and accurate emergency medical treatment, and require emergency medical staff to possess rich medical knowledge and accurate judgment.

Although the development of emergency medicine is confronted with quite a few challenges, it has entered the era of communication among various schools of thought. This journey provides opportunities to the field of emergency medicine. With the joint efforts and hard work of stakeholders worldwide, emergency medicine will accomplish more historic advancements.

Conflict of interest statement

Shujian Wei is the Executive Editor of Emergency and Critical Care Medicine . The author declares no conflicts of interest.

Author contributions

Shujian Wei wrote the article.

Ethical approval of studies and informed consent

Acknowledgements.

• Cited Here |
• Google Scholar
• PubMed | CrossRef |
• View Full Text | PubMed | CrossRef |
• + Favorites
• View in Gallery

Readers Of this Article Also Read

Bioinformatics analysis of sars-cov-2 infection-associated immune injury and..., emergency medicine and covid-19: now and next year, new problems and countermeasures in the prevention and control of covid-19, expert consensus by qilu hospital of shandong university on the diagnosis,..., treatment of acute pulmonary edema by blocking vegf-induced vascular leakage.

Emergency Medicine Journal

is an international peer-reviewed journal covering pre-hospital, hospital emergency medicine and critical care

Impact Factor: 3.814 Citescore: 3.4 All metrics >>

Emergency Medicine Journal (EMJ) is a Plan S compliant Transformative Journal .

Emergency Medicine Journal is an international peer review journal covering pre-hospital and hospital emergency medicine, and critical care. The journal publishes original research, evidence-based reviews and commentaries on resuscitation, trauma, minor injuries, disaster preparedness and response, toxicology, acute medical and paediatric emergencies, diagnostic testing, teaching, clinical operations, decision making and reflections on clinical practice. The journal is aimed at doctors, nurses, paramedics and ambulance staff.

Editor-in-Chief: Professor Ellen Weber, University of California, San Francisco, USA Editorial team

Latest information and guidance from the Royal College of Emergency Medicine .

Emergency Medicine Journal accepts submissions of a wide range of article types, including original research, reviews and image challenges.

The Author Information section provides specific article requirements to help you turn your research into an article suitable for EMJ.

Information is also provided on editorial policies and open access .

Latest Articles

Original research :

27 July 2023

Sono case series :

25 July 2023

21 July 2023

Practice review :

19 July 2023

16 June 2023

6 June 2023

26 May 2023

22 May 2023

26 April 2023

Most Read Articles

21 October 2022

17 April 2023

Systematic review :

12 May 2023

23 August 2022

Editor's Choice

Research letter :

15 February 2023

28 February 2023

9 November 2022

Related Journals

BMJ Military Health

Trauma Surgery & Acute Care Open

Dublin, Ireland (IE)

Recruiter: Tallaght University Hospital

Isle of Man (GB) (IM)

Recruiter: Isle of Man Government Secondary Care

Ireland (IE)

Recruiter: Rosata Recruitment

Recruiter: Leeds Teaching Hospitals NHS Trust

• Search by keyword
• Search by citation

Page 1 of 26

Take-home naloxone administered in emergency settings: feasibility of intervention implementation in a cluster randomized trial

Opioids kill more people than any other class of drug. Naloxone is an opioid antagonist which can be distributed in kits for peer administration. We assessed the feasibility of implementing a Take-home Naloxon...

• View Full Text

Negotiating grey areas: an interview-based analysis of paramedic uncertainty and decision-making in cardiac arrest events

Paramedics are responsible for critical resuscitation decisions when attending Out of Hospital Cardiac Arrests (OHCA). Existing research indicates that a range of clinical and non-clinical factors moderate the...

The impact of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response: an action research study

Hospitals as the main providers of healthcare services play an essential role in the management of disasters and emergencies. Nurses are one of the important and influential elements in increasing the surge ca...

Paramedics’ experiences and observations: work-related emotions and well-being resources during the initial months of the COVID-19 pandemic—a qualitative study

As first responders, paramedics are an extremely important part of the care chain. COVID-19 significantly impacted their working circumstances. We examined, according to the experiences and observations of par...

Psychometric properties of the Farsi version of the Disaster Nursing Readiness Evaluation Index (F-DNREI)

Considering the vital role of nurses in responding to disasters, it is essential to measure their readiness with a valid and reliable tool. The present study aimed to assess the psychometric properties of the ...

Severe hyperlactatemia in the emergency department: clinical characteristics, etiology and mortality

Severe hyperlactatemia (lactate level ≥ 10 mmol/L) is associated with high mortality rates in critically ill patients. However, there is limited data on emergency department (ED) patients. We aimed to investig...

Identification of avoidable patients at triage in a Paediatric Emergency Department: a decision support system using predictive analytics

Crowding has been a longstanding issue in emergency departments. To address this, a fast-track system for avoidable patients is being implemented in the Paediatric Emergency Department where our study is condu...

Establishing a common ground: the future of triage systems

Triage systems, crucial for Emergency Departments, face unresolved doubts and issues that have not been addressed, coupled with increasing fragmentation due to a growing body of new evidence. International col...

Abated crowding by fast-tracking the Throughput component of the ED for patients in no need of hospitalization with competency managed personnel

Emergency department (ED) crowding is a major patient safety concern and has a negative impact on healthcare systems and healthcare providers. We hypothesized that it would be feasible to control crowding by e...

Oxygen accumulation and associated dangers in rescue helicopters

At the time of the COVID-19 pandemic, devastating incidents increased due to frequent oxygen administration to patients. The dangers associated with the use of oxygen, especially through local enrichments and ...

Correction: Systemic review of age brackets in pediatric emergency medicine literature and the development of a universal age classification for pediatric emergency patients - the Munich Age Classification System (MACS)

The original article was published in BMC Emergency Medicine 2023 23 :77

Validation of a checklist to facilitate serious illness conversations in adult emergency in China: a single-centre pilot study

Advances in emergency and critical care have improved outcomes, but gaps in communication and decision-making persist, especially in the emergency department (ED), prompting the development of a checklist to a...

A retrospective analysis of the need for on-site emergency physician presence and mission characteristics of a rural ground-based emergency medical service

This study aimed to address the challenges faced by rural emergency medical services in Europe, due to an increasing number of missions and limited human resources. The primary objective was to determine the n...

Emergency department visits as a potential opportunity to promote primary care attachment and modify utilization patterns – results of a pilot study in Berlin, Germany

Utilization by low acuity patients contributes to emergency department (ED) crowding. Both knowledge deficits about adequate care levels and access barriers in primary care are important promoters of such pres...

Blood pressure variability and prognostic significance in traumatic brain injury: analysis of the eICU-CRD database

Preliminary evidence demonstrates that visit-to-visit systolic blood pressure (SBP) variability is a prognostic factor of TBI. However, literature regarding the impact of initial blood pressure management on t...

Out of hospital cardiac arrest - new insights and a call for a worldwide registry and guidelines

Out of hospital cardiac arrest (OHCA) is a major public health problem with substantial mortality rates worldwide. Genetic diseases and primary electrical disorders are the most common etiologies at younger ag...

Unveiling the performance of the prehospital Rapid Emergency Medicine Score (pREMS): How the predictive score impacts in-hospital outcomes in traumatic brain injury (TBI): A retrospective observational cohort study

This study aimed to evaluate the predictive accuracy of the prehospital rapid emergency medicine score (pREMS) for predicting the outcomes of hospitalized patients with traumatic brain injury (TBI) who died, w...

Magnitude and outcome of road traffic accidents among patients admitted in dessie town governmental hospitals, Northeast Amhara, Ethiopia, 2022

Road traffic accidents(RTA) are a major public health problem worldwide, accounting for almost 1.24 million deaths per year and it is the number one cause of death among those aged group 15–29 years. Even thou...

A novel learner driver first aid eLearning program: a mixed-method pre-post pilot test and evaluation

Approximately 1.35 million people worldwide are killed in road accidents every year. Mandatory first aid training for learner drivers has been introduced in some European countries but no such requirements are...

Implementation of major trauma app: usability and data completeness

The current UK standard for major trauma patients is to record notes in a paper trauma booklet. Through an innovative collaboration between a major trauma centre and a digital transformation industry partner, ...

Identifying the key characteristics, trends, and seasonality of pedestrian traffic injury at a major trauma center in Saudi Arabia: a registry-based retrospective cohort study, 2017–2022

Pedestrian traffic injuries are a rising public health concern worldwide. In rapidly urbanizing countries like Saudi Arabia, these injuries account for a considerable proportion of trauma cases and represent a...

Emergency department utilization before and during the COVID-19 pandemic among individuals with sickle cell disease

The emergency department (ED) is a vital source of healthcare for individuals living with sickle cell disease (SCD). Prior research indicates that during the COVID-19 pandemic some individuals with SCD avoided...

Emergency preparedness in the central sterile supply department: a multicenter cross-sectional survey

To investigate the current situation of emergency preparation and emergency drill in the CSSD, and analyze its influence on the nurses’ emergency attitude and ability.

Fracture pain in children in the emergency department: the impact of a new pain management procedure

To compare compliance with the French national guidelines before and after the implementation (in 2018) of a new protocol on acute fracture pain management in the pediatric emergency department of a French uni...

Development and psychometric testing of a scale to measure effective rural emergency transfer (RET)

The process of transferring patients from small rural primary care facilities to referral facilities impacts the quality of care and effectiveness of the referral healthcare system. The study aimed to develop ...

New Trauma Score versus Kampala Trauma Score II in predicting mortality following road traffic crash: a prospective multi-center cohort study

Mortality due to injuries disproportionately impact low income countries. Knowledge of who is at risk of poor outcomes is critical to guide resource allocation and prioritization of severely injured. Kampala T...

The prevalence of physical and verbal violence among emergency medicine physicians in military hospitals vs non-military hospitals, Jeddah, Saudi Arabia: multi-center cross-sectional study

In healthcare settings, physical and verbal attacks are commonly encountered in the workplace among healthcare providers. Patients and patients’ relatives and friends have been reported to be the perpetrators ...

Comparison of prognosis between extracorporeal CPR and conventional CPR for patients in cardiac arrest: a systematic review and meta-analysis

Compared to the conventional cardiopulmonary resuscitation (CCPR), potential benefits of extracorporeal cardiopulmonary resuscitation (ECPR) for patients with cardiac arrest (CA) are still controversial. We ai...

Designing a model of emergency medical services preparedness in response to mass casualty incidents: a mixed-method study

Emergency medical services preparedness in mass casualty incidents is one of the most important concerns in emergency systems. A mass casualty incident is a sudden event with several injured individuals that o...

Correction: Emergency medical care of patients with psychiatric disorders - challenges and opportunities: Results of a multicenter survey

The original article was published in BMC Emergency Medicine 2022 22 :173

Mortality and its determinants among patients attending in emergency departments

Due to the high burden of mortality from acute communicable and non-communicable diseases, emergency department’s mortality has become one of the major health indices in Ethiopia that should be evaluated regul...

What role does compassion have on quality care ratings? A regression analysis and validation of the SCQ in emergency department patients

To examine the unique contribution of patient reported experiences of compassion to overall patient quality care ratings. Additionally, we assess whether patients’ reported experiences of compassion in the eme...

Identifying the obstacles facing emergency nurses regarding treating CTAS1 and CTAS2 in Saudi Arabia

Emergency nurses play a pivotal role in delivering efficient emergency healthcare, yet they often encounter numerous challenges, especially while managing life-threatening cases, impacting both their well-bein...

Functional somatic symptoms in Emergency Department frequent presenters

Patients with Functional Somatic Symptoms (FSS) are frequently encountered within healthcare settings such as Emergency Departments (ED). There is limited research regarding characterisation and frequency of F...

Epidemiology of maxillofacial trauma in elderly patients receiving oral anticoagulant or antithrombotic medication; a Swiss retrospective study

The percentage of elderly trauma patients under anticoagulation and antiplatelet agents has been rising lately. As newer agents are introduced, each comes with its own advantages and precautions. Our study cov...

Diagnostic agreement between emergency medical service and emergency department physicians, a prospective multicentre study

Early and adequate preliminary diagnosis reduce emergency department (ED) and hospital stay and may reduce mortality. Several studies demonstrated adequate preliminary diagnosis as stated by emergency medical ...

Evaluation of the role of repeated inferior vena cava sonography in estimating first 24 h fluid requirement in resuscitation of major blunt trauma patients in emergency department Suez Canal University Hospital

The assessment of hemodynamic status in polytrauma patients is an important principle of the primary survey of trauma patients, and screening for ongoing hemorrhage and assessing the efficacy of resuscitation ...

Exploring differences in patient participation in simulated emergency cases in co-located and distributed rural emergency teams – an observational study with a randomized cross-over design

In northern rural Sweden, telemedicine is used to improve access to healthcare and to provide patient-centered care. In emergency care during on-call hours, video-conference systems are used to connect the phy...

Non-emergency department (ED) interventions to reduce ED utilization: a scoping review

Emergency department (ED) crowding is a global burden. Interventions to reduce ED utilization have been widely discussed in the literature, but previous reviews have mainly focused on specific interventions or...

Diagnostic performance of coronary calcifications on CT to rule out acute coronary syndrome in the emergency department

At present, the diagnosis of acute coronary syndrome (ACS) can be made by emergency physicians using the usual complementary tests, since the current troponin and electrocardiogram (ECG) protocols have been ex...

Exploring paramedics’ lived experiences in confrontation with patients’ death during missions: a phenomenological study

Emergency personnel are the first line of emergency response systems to respond to emergencies; in essence, they are usually exposed to a wide range of physical and psychological problems. Accordingly, the cur...

Improving the introduction of telemedicine in pre-hospital emergency medicine: understanding users and how acceptability, usability and effectiveness influence this process

Increasing numbers of ambulance calls, vacant positions and growing workloads in Emergency Medicine (EM) are increasing the pressure to find adequate solutions. With telemedicine providing health-care services...

Analysis of barriers associated with emergency medical service activation in patients with acute stroke and acute myocardial infarction from Zhongjiang County of Sichuan Province in China

The purpose of this study was to investigate the preferred modes of transportation to the hospital among patients with acute stroke and acute myocardial infarction (AMI), as well as to identify the factors tha...

Development of training program for the Eye, Ear, Nose, and Throat emergency nurses in China based on core competency: a Delphi study

Nursing work in the Eye, Ear, Nose, and Throat (EENT) emergency department is highly specialised and faces significant challenges. Therefore, a high level of nursing competence is necessary for nurses. To deve...

The accuracy of predicting hospital admission by emergency medical service and emergency department personnel compared to the prehospital MEWS: a prospective multicenter study

Overcrowding in the emergency department (ED) is a global problem. Early and accurate recognition of a patient’s disposition could limit time spend at the ED and thus improve throughput and quality of care pro...

Prior emergency medical services utilization is a risk factor for in-hospital death among patients with substance misuse: a retrospective cohort study

Substance misuse poses a significant public health challenge, characterized by premature morbidity and mortality, and heightened healthcare utilization. While studies have demonstrated that previous hospitaliz...

Improving the non-structural preparedness of the selected hospital based on the FOCUS-PDCA 1 model: action research

With the intensification of the country’s development process, the expansion of cities and population, and the inclusion of Iran in the accident-prone category, reducing the vulnerability of non-structures has...

Ambulance professionals' experiences of teamwork in the context of a team training programme – a qualitative study

Teamwork in the context of ambulance services exhibits unique characteristics, as this environment involves a small core team that must adapt to a dynamic team structure that involves health care professionals...

Primary care doctors in acute call-outs to severe trauma incidents in Norway – variations by rural-urban settings and time factors

A severely injured patient needs fast transportation to a hospital that can provide definitive care. In Norway, approximately 20% of the population live in rural areas. Primary care doctors (PCDs) play an impo...

Exploring stress management strategies among emergency medical service providers in Iran: a qualitative content analysis

Emergency medical service providers are frequently exposed to a variety of stressors as a result of their work environment. These stressors can have detrimental effects on both the physical and mental well-bei...

Important information

Editorial board

For authors  

For editorial board members

For reviewers

• Manuscript editing services

Annual Journal Metrics

Citation Impact 2023 Journal Impact Factor: 2.3 5-year Journal Impact Factor: 2.5 Source Normalized Impact per Paper (SNIP): 0.936 SCImago Journal Rank (SJR): 0.745 Speed 2023 Submission to first editorial decision (median days): 14 Submission to acceptance (median days): 164 Usage 2023 Downloads: 1,251,999 Altmetric mentions: 586

• More about our metrics

Peer-review Terminology

The following summary describes the peer review process for this journal:

Identity transparency: Single anonymized

Reviewer interacts with: Editor

Review information published: Review reports. Reviewer Identities reviewer opt in. Author/reviewer communication

More information is available here

• Follow us on Twitter

BMC Emergency Medicine

ISSN: 1471-227X

• General enquiries: [email protected]

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

The top 100 cited articles published in emergency medicine journals

Affiliations.

• 1 Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA; Department of Emergency Medicine, Hospital General de la Plaza de Salud, Santo Domingo, Dominican Republic. Electronic address: [email protected].
• 2 Department of Clinical Epidemiology and Public Health, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic.
• 3 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
• 4 Department of Emergency Medicine, Hospital General de la Plaza de Salud, Santo Domingo, Dominican Republic.
• 5 Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY.
• PMID: 25979301
• DOI: 10.1016/j.ajem.2015.04.047

Introduction: Our objective was to identify trends and examine the characteristics of the top 100 cited articles in emergency medicine (EM) journals.

Methods: Scopus Library database was queried to determine the citations of the top 100 EM articles. A second database (Google Scholar) was used to gather the following information: number of authors, publication year, journal name, impact factor, country of origin, and article type (original article, review article, conference paper, or editorial). The top 100 cited articles were selected and analyzed by 2 independent investigators.

Results: We identified 100 top-cited articles published in 6 EM journals, led by Annals of Emergency Medicine (65) and American Journal of Emergency Medicine (15). All top-cited articles were published between 1980 and 2009. The common areas of study were categorized as cardiovascular medicine, emergency department administration, toxicology, pain medicine, pediatrics, traumatology, and resuscitation. A statistically significant association was found between the journal impact factor and the number of top 100 cited articles (P < .005).

Conclusion: The top-cited articles published in EM journals help us recognize the quality of the works, discoveries, and trends steering EM. Our analysis provides an insight to the prevalent areas of study being cited within our field of practice.

Copyright © 2015 Elsevier Inc. All rights reserved.

PubMed Disclaimer

• Am J Emerg Med. 2015 Dec;33(12):1837-8
• Top cited articles and journal impact factors. Lee CH. Lee CH. Am J Emerg Med. 2015 Dec;33(12):1837. doi: 10.1016/j.ajem.2015.09.023. Epub 2015 Sep 21. Am J Emerg Med. 2015. PMID: 26458535 No abstract available.
• The author replies. Shuaib W. Shuaib W. Am J Emerg Med. 2015 Dec;33(12):1837-8. Am J Emerg Med. 2015. PMID: 27010044 No abstract available.

Similar articles

• Top-cited articles in emergency medicine. Tsai YL, Lee CC, Chen SC, Yen ZS. Tsai YL, et al. Am J Emerg Med. 2006 Oct;24(6):647-54. doi: 10.1016/j.ajem.2006.01.001. Am J Emerg Med. 2006. PMID: 16984831
• Bibliometric analysis of the top 100 cited cardiovascular articles. Shuaib W, Khan MS, Shahid H, Valdes EA, Alweis R. Shuaib W, et al. Am J Cardiol. 2015 Apr 1;115(7):972-81. doi: 10.1016/j.amjcard.2015.01.029. Epub 2015 Jan 15. Am J Cardiol. 2015. PMID: 25670637 Review.
• An Analysis of the Top-cited Articles in Emergency Medicine Education Literature. Munzer BW, Love J, Shipman BL, Byrne B, Cico SJ, Furlong R, Khandelwal S, Santen SA. Munzer BW, et al. West J Emerg Med. 2017 Jan;18(1):60-68. doi: 10.5811/westjem.2016.10.31492. Epub 2016 Nov 23. West J Emerg Med. 2017. PMID: 28116010 Free PMC article.
• The 100 top-cited articles published in psychiatric journals. Mazhari S. Mazhari S. J Psychiatr Pract. 2013 Jul;19(4):327-38. doi: 10.1097/01.pra.0000432604.06835.da. J Psychiatr Pract. 2013. PMID: 23852109
• Top-cited articles in endodontic journals. Fardi A, Kodonas K, Gogos C, Economides N. Fardi A, et al. J Endod. 2011 Sep;37(9):1183-90. doi: 10.1016/j.joen.2011.05.037. Epub 2011 Jul 20. J Endod. 2011. PMID: 21846531 Review.
• A Bibliometric Analysis of the Top 100 Cited Papers in Retinal Detachment. Asahi MG, Pakhchanian H, Doepker C, Raiker R, Gallemore RP. Asahi MG, et al. J Vitreoretin Dis. 2021 May 18;5(6):467-478. doi: 10.1177/24741264211007378. eCollection 2021 Nov-Dec. J Vitreoretin Dis. 2021. PMID: 37007181 Free PMC article.
• A bibliometric analysis of systematic reviews and meta-analyses in ophthalmology. Fu Y, Mao Y, Jiang S, Luo S, Chen X, Xiao W. Fu Y, et al. Front Med (Lausanne). 2023 Mar 2;10:1135592. doi: 10.3389/fmed.2023.1135592. eCollection 2023. Front Med (Lausanne). 2023. PMID: 36936241 Free PMC article.
• Global trends of dalbavancin: A bibliometric analysis. Monteagudo-Martínez N, Solís García Del Pozo J, Ikuta I, Galindo MF, Jordán J. Monteagudo-Martínez N, et al. J Clin Pharm Ther. 2022 Sep;47(9):1299-1311. doi: 10.1111/jcpt.13719. Epub 2022 Jun 23. J Clin Pharm Ther. 2022. PMID: 35735062 Free PMC article. Review.
• The latest research trends in primary biliary cholangitis: a bibliometric analysis. Zhao Y, Yin Z, Du H, Huang K, Zhang F, Chen H. Zhao Y, et al. Clin Exp Med. 2023 Jun;23(2):347-355. doi: 10.1007/s10238-022-00825-0. Epub 2022 Apr 7. Clin Exp Med. 2023. PMID: 35389157
• Endodontic Microbiology: A Bibliometric Analysis of the Top 50 Classics. Karobari MI, Maqbool M, Ahmad P, Abdul MSM, Marya A, Venugopal A, Shaik GM, Scardina GA, Messina P, Noorani TY. Karobari MI, et al. Biomed Res Int. 2021 Jun 1;2021:6657167. doi: 10.1155/2021/6657167. eCollection 2021. Biomed Res Int. 2021. PMID: 34746305 Free PMC article. Review.
• Search in MeSH

LinkOut - more resources

Full text sources.

• Elsevier Science
• Ovid Technologies, Inc.
• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Log in using your username and password

• Search More Search for this keyword Advanced search
• Latest content
• Current issue
• BMJ Journals

You are here

• Volume 19, Issue 3
• Clinical research in emergency medicine: putting it together
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

• A M T Good 1 ,
• P Driscoll 2
• 1 Accident and Emergency Department, Royal Liverpool University Hospital, Liverpool, UK
• 2 Accident and Emergency Department, Hope Hospital, Salford, UK
• Correspondence to:
 Dr A M T Good, Accident and Emergency Department, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK;
 Anthony.Good{at}rlbuh-tr.nwest.nhs.uk

The difficulties in conducting good clinical research in emergency medicine can be overcome. This article will begin by identifying the main difficulties faced by the emergency medicine researcher. It will then discuss some solutions through the development and application of the research protocol. Finally, recommendations will be made with regard to writing for publication.

• clinical research

https://doi.org/10.1136/emj.19.3.242

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Read the full text or download the PDF:

Research & Innovation

Leading in the advancement of emergency medicine through innovation and scientific discovery..

Emergency Medicine is a rapidly-developing field, and Stanford is leading research in many facets of care. The department benefits from collaboration with other disciplines at Stanford, within local Silicon Valley, and across the globe.

Stanford is leading research efforts to transform health care for  all  through Precision EM. Precision Emergency Medicine utilizes information and technology to effectively, efficiently, and authentically deliver acute care for our patients and our communities.

RESEARCH AREAS INCLUDE: Pre-hospital Care; AI; Telehealth; Informatics; Medical Education; Pediatric EM; Global EM; Population Health; Wilderness Medicine; Ultrasound; Wellness; and Diagnostics.

Join us for StEMI X 2024 on October 17!

Our fourth annual symposium on emergency medicine innovation is free and open to all!  Learn more

Stanford Emergency Medicine Magazine

Download PDF

PROFILES IN INNOVATION

Take a deeper dive into select emergency medicine research initiatives at Stanford, from informatics, to diagnostics, to education. More   

PUBLISHED RESEARCH

Browse through our online database of  recent publications 

FACULTY LABS & CENTERS

Precision Education and Assessment Research Lab  (PEARL)

Global Pediatric Emergency Equity Lab

Emergency Care Health Services Research Data Coordinating Center

The Bennett Lab

Stanford Department of Emergency Medicine Seed Grants

Since 2020 Stanford University’s Department of Emergency Medicine has awarded seed grants that encourage early-career physician-scientists in the department to explore new territories in emergency medicine. Read about the recipients

Quick Links

• Stanford Clinical Trials Directory
• National Institutes of Health
• Society for Academic Emergency Medicine
• American College of Emergency Physicians
• American Academy of Emergency Medicine
• Wilderness Medical Society
• Annals of Emergency Medicine
• Academic Emergency Medicine
• American Journal of Emergency Medicine
• Journal of Emergency Medicine
• Emergency Medicine Journal
• European Journal of Emergency Medicine