Academic Emergency Medicine (ACAD EMERG MED )

Publisher: Society for Academic Emergency Medicine (U.S.), Blackwell Publishing


AEM is a monthly peer-reviewed journal that publishes material relevant to the practice, education, and investigation of emergency medicine, and reaches a wide audience of emergency care practitioners and educators. Each issue contains a broad range of topics relevant to the improvement of emergency, urgent, or critical care of the acutely ill or injured patient. Regular features include original research, preliminary reports, education & practice, annotated literature.

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    Academic emergency medicine
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Blackwell Publishing

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Significant sex and gender differences in both physiology and psychology are readily acknowledged between men and women; however, data are lacking regarding differences in their responses to injury and treatment and in their ultimate recovery and survival. These variations remain particularly poorly defined within the field of cardiovascular resuscitation. A better understanding of the interaction between these important factors may soon allow us to dramatically improve outcomes in disease processes that currently carry a dismal prognosis, such as sudden cardiac arrest. As part of the 2014 Academic Emergency Medicine consensus conference "Gender-Specific Research in Emergency Medicine: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," our group sought to identify key research questions and knowledge gaps pertaining to both sex and gender in cardiac resuscitation that could be answered in the near future to inform our understanding of these important issues. We combined a monthly teleconference meeting of interdisciplinary stakeholders from largely academic institutions with a focused interest in cardiovascular outcomes research, an extensive review of the existing literature, and an open breakout session discussion on the recommendations at the consensus conference to establish a prioritization of the knowledge gaps and relevant research questions in this area. We identified six priority research areas: 1) out-of-hospital cardiac arrest epidemiology and outcome, 2) customized resuscitation drugs, 3) treatment role for sex steroids, 4) targeted temperature management and hypothermia, 5) withdrawal of care after cardiac arrest, and 6) cardiopulmonary resuscitation training and implementation. We believe that exploring these key topics and identifying relevant questions may directly lead to improved understanding of sex- and gender-specific issues seen in cardiac resuscitation and ultimately improved patient outcomes. © 2014 by the Society for Academic Emergency Medicine.
    Academic Emergency Medicine 12/2014; 21(12):1343-9.
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    ABSTRACT: Over the past two decades, a burgeoning interest in women's health, the direct consequence of the feminist movement, has inspired a worldwide interest in the differences between the normal function of men and women and their unique experiences of the same illnesses. The scope and significance of what we have discovered and continue to find has fundamentally changed the way we prevent, diagnose, and treat diseases. Important questions remain, however, and deserve specific investigation and analysis.
    Academic Emergency Medicine 12/2014; 21(12).
  • [Show abstract] [Hide abstract]
    ABSTRACT: The 2014 Academic Emergency Medicine consensus conference has taken the first step in identifying gender-specific care as an area of importance to both emergency medicine (EM) and research. To improve patient care, we need to address educational gaps in this area concurrent with research gaps. In this article, the authors highlight the need for sex- and gender-specific education in EM and propose guidelines for medical student, resident, and faculty education. Specific examples of incorporating this content into grand rounds, simulation, bedside teaching, and journal club sessions are reviewed. Future challenges and strategies to fill the gaps in the current education model are also described. © 2014 by the Society for Academic Emergency Medicine.
    Academic Emergency Medicine 12/2014; 21(12):1453-1458.
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    ABSTRACT: The primary objective of this study was to determine whether patient-described pain correlates with patient-described stress, anxiety, and satisfaction with ongoing treatment and if that correlation differs by gender. This was a prospective observational study at an urban, Level I trauma center conducted between June 1, 2010, and January 1, 2013. Patients reporting pain rated greater than 3 of 10 were eligible. Patients who qualified and consented for participation completed demographic and pain, anxiety, stress, and satisfaction scales at baseline, every 30 minutes, and at discharge. Data were analyzed using analysis of variance, chi-square tests, t-tests, multiple regression, and the Wilcoxon-Mann-Whitney rank test. A total of 7,124 patients were screened for enrollment. Of those, 3,495 (49%) did not qualify at screening for various reasons, including insufficient pain levels (17.5%), elected not to participate (37.7%), did not qualify for other reasons (12.4%), and reason not captured (32.4%). A total of 3,629 (51%) screened patients were eligible and consented. Of those, 620 (16.8%) did not have any data collected past baseline, leaving 3,009 as the final sample size. The patients completing data collection had a median age of 39 years (range = 18 to 90 years), and 50% were male. The mean presenting pain visual analog scale (VAS) score was 71.5 mm. Presenting stress and anxiety VAS scores were significantly higher in females (0.61 and 0.53, respectively) than males (0.56 and 0.50, respectively), whereas presenting pain VAS (0.71 male and 0.72 female) and satisfaction VAS (0.34 male and 0.35 female) did not differ by sex. Ethnicity, education, and income were all statistically different when compared with baseline pain, stress, anxiety, and satisfaction. Male gender was associated with a significant change in pain over time from baseline (coefficient = 0.040, p = 0.037); however, when adjusting for age, ethnicity, education, and income, and for changes in stress, anxiety, and satisfaction VAS scores, changes in pain related to male gender was no longer significant (coefficient = 0.034, p = 0.11). When asked about their satisfaction with the results of the pain treatment that had been provided, patients reported a median of 2 (out of 6, 1 = satisfied, 6 = dissatisfied; interquartile range = 1 to 2). There was no significant difference between sexes (p > 0.90). Patient-reported stress and anxiety were higher among female patients than male patients, but there was no significant difference in reported pain and satisfaction between sexes. Sex alone was not a significant predictor of change in pain for patients presenting to the emergency department with pain-related complaints. Anxiety and stress may potentially influence the pain-gender relationship. © 2014 by the Society for Academic Emergency Medicine.
    Academic Emergency Medicine 12/2014; 21(12):1478-1484.
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    ABSTRACT: To the best of the authors' knowledge, gender differences in nonmedical opioid presentations to the emergency department (ED) have not been studied. The objective was to explore gender differences in ED visits related to nonmedical prescription opioid use in a nationally representative sample. Se analizaron los datos desde 2001 del Department of Health and Human Services Substance Abuse and Mental Health Services Administration's Drug Abuse Warning Network (DAWN) para comparar las características entre las visitas entre varones y mujeres. Se desarrollaron modelos de regresión logística para examinar la asociación entre el género y las atenciones específicas por drogas y los resultados clínicos. Hubo una estimación de 426.010 visitas definidas por DAWN involucradas con la prescripción de fármacos opiáceos en 2011. La prevalencia de fármacos en las visitas relacionadas con fármacos opiáceos fue similar entre las mujeres y los varones. La ingestión de otro fármaco junto con los fármacos opiáceos se asoció con un riesgo incrementado de ingreso hospitalario tanto para las mujeres como para los varones, y los tipos de fármacos opiáceos ingeridos fueron similares entre las mujeres y los varones. Sin embargo, hubo diferencias entre géneros en los resultados clínicos dependiendo de la combinación específica de fármacos. Las diferencias de género existen en la atenciones en el SU relacionadas con la prescripción de opiáceos. Se precisa de futuras investigaciones para comprender estas diferencias y cualquiera de sus implicaciones en la atención de urgencias específicas de género e intervenciones breves. Spanish Según el conocimiento de los autores, las diferencias de género en las atenciones no médicas al Servicio de Urgencias (SU) no se han estudiado. El objetivo fue explorar las diferencias en función del género en las visitas relacionadas con el uso de opiáceos no prescritos por médicos en un muestra representativa nacional.
    Academic Emergency Medicine 12/2014; 21(12).
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Centers for Disease Control and Prevention report that among older adults (≥65 years), falls are the leading cause of injury-related death. Fall-related fractures among older women are more than twice as frequent as those for men. Gender-specific evidence-based fall prevention strategy and intervention studies show that improved patient-centered outcomes are elusive. There is a paucity of emergency medicine literature on the topic. As part of the 2014 Academic Emergency Medicine (AEM) consensus conference on "Gender-Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," a breakout group convened to generate a research agenda on priority questions to be answered on this topic. The consensus-based priority research agenda is presented in this article. © 2014 by the Society for Academic Emergency Medicine.
    Academic Emergency Medicine 12/2014; 21(12):1380-5.
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    ABSTRACT: The objective of this study was to test the effect of a brief educational and counseling intervention on increasing the uptake of free testing for Chlamydia trachomatis (chlamydia) and Neisseria gonorrhea (gonorrhea) among young female emergency department (ED) patients. Women are particularly vulnerable to more serious consequences of these infections due to asymptomatic presentation. Increased testing is important to detect, treat, and halt the spread of these infections among asymptomatic women. This was a randomized controlled trial. Research assistants (RAs) approached female patients in two EDs. Eligible patients were between 18 and 35 years of age, who reported having sex with males, but were not attending the ED for either treatment of sexually transmitted infection (STI) or testing for possible STI exposure. Participants responded to survey questions about their lifetime and past 3-month substance use, number of recent sexual partners, condom use, and perception of risks for chlamydia and gonorrhea infections. Following the survey, the RAs randomized participants into study control or treatment arms. Each treatment arm participant received a brief educational/counseling intervention from the RA. The brief intervention focused on the woman's personal risks for chlamydia and gonorrhea and condoms attitudes and usage. As the primary outcome of this study, participants were offered free urine tests for chlamydia and gonorrhea infection postintervention or post-survey completion, depending on group assignment. A total of 171 women completed the baseline assessment and were offered chlamydia and gonorrhea testing. The mean (±SD) age was 26 (±4.76) years, 18% were Hispanic, and 12% were Spanish-speaking only. The brief intervention that was offered to increase these women's awareness of their STI risk did not result in increased acceptance of testing; 48% in the brief intervention group accepted testing (95% confidence interval [CI] = 32% to 64%) versus 36% in the control group (95% CI = 19% to 53%). In a multivariable logistic regression, only self-identifying as being Hispanic was associated with greater willingness to be tested. Of the asymptomatic women tested (n = 71), five tested positive for chlamydia. This represents a positivity rate of 7%. There were no positive test results for gonorrhea. Women who reported high-risk factors for STI, such as younger age (≤25 years), having sex in the past 90 days without using condoms, identified substance use, or previous STI, were not more likely to accept the offer of chlamydia and gonorrhea testing. The brief intervention used in this study did not increase the uptake of testing for chlamydia and gonorrhea infections in this sample, in comparison to receiving no intervention. Although Hispanic women were more likely to accept chlamydia and gonorrhea testing, it is concerning that those women who report STI risk factors were not more likely to accept the offer of chlamydia and gonorrhea testing. Future research should focus on the refinement of an intervention protocol to focus on prior STI and lack of condom use to increase the uptake of testing among this high-risk group. © 2014 by the Society for Academic Emergency Medicine.
    Academic Emergency Medicine 12/2014; 21(12):1512-1520.
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    ABSTRACT: Emergency physicians are confronted daily with the care of traumatically injured patients. A considerable proportion of blunt trauma cases are due to motor vehicle crashes. While men have historically been overrepresented in crash-related injuries and deaths, unfavorable trends for women in alcohol-impaired driving crashes have emerged. This extended commentary with in-depth review presents an examination of the evolving role of sex and gender in alcohol-impaired driving and its outcomes. © 2014 by the Society for Academic Emergency Medicine.
    Academic Emergency Medicine 12/2014; 21(12):1485-1492.
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    ABSTRACT: Coronary artery disease (CAD) is the most common cause of death for both men and women. However, over the years, emergency physicians, cardiologists, and other health care practitioners have observed varying outcomes in men and women with symptomatic CAD. Women in general are 10 to 15 years older than men when they develop CAD, but suffer worse postinfarction outcomes compared to age-matched men. This article was developed by the cardiovascular workgroup at the 2014 Academic Emergency Medicine (AEM) consensus conference to identify sex- and gender-specific gaps in the key themes and research questions related to emergency cardiac ischemia care. The workgroup had diverse stakeholder representation from emergency medicine, cardiology, critical care, nursing, emergency medical services, patients, and major policy-makers in government, academia, and patient care. We implemented the nominal group technique to identify and prioritize themes and research questions using electronic mail, monthly conference calls, in-person meetings, and Web-based surveys between June 2013 and May 2014. Through three rounds of nomination and refinement, followed by an in-person meeting on May 13, 2014, we achieved consensus on five priority themes and 30 research questions. The overarching themes were as follows: 1) the full spectrum of sex-specific risk as well as presentation of cardiac ischemia may not be captured by our standard definition of CAD and needs to incorporate other forms of ischemic heart disease (IHD); 2) diagnosis is further challenged by sex/gender differences in presentation and variable sensitivity of cardiac biomarkers, imaging, and risk scores; 3) sex-specific pathophysiology of cardiac ischemia extends beyond conventional obstructive CAD to include other causes such as microvascular dysfunction, takotsubo, and coronary artery dissection, better recognized as IHD; 4) treatment and prognosis are influenced by sex-specific variations in biology, as well as patient-provider communication; and 5) the changing definitions of pathophysiology call for looking beyond conventionally defined cardiovascular outcomes to patient-centered outcomes. These emergency care priorities should guide future clinical and basic science research and extramural funding in an area that greatly influences patient outcomes. © 2014 by the Society for Academic Emergency Medicine.
    Academic Emergency Medicine 11/2014;
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    ABSTRACT: Low-dose ketamine has been used perioperatively for pain control and may be a useful adjunct to intravenous (IV) opioids in the control of acute pain in the emergency department (ED). The aim of this study was to determine the effectiveness of low-dose ketamine as an adjunct to morphine versus standard care with morphine alone for the treatment of acute moderate to severe pain among ED patients.
    Academic Emergency Medicine 11/2014; 21(11):1193-1202.
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    ABSTRACT: Easily administrated cyanide antidotes are needed for first responders, military troops, and emergency department staff after cyanide exposure in mass casualty incidents or due to smoke inhalation during fires involving many victims. Hydroxocobalamin has proven to be an effective antidote, but cannot be given intramuscularly because the volume of diluent needed is too large. Thus, intraosseous (IO) infusion may be an alternative, as it is simple and has been recommended for the administration of other resuscitation drugs. The primary objective of this study was to compare the efficacy of IO delivery of hydroxocobalamin to intravenous (IV) injection for the management of acute cyanide toxicity in a well-described porcine model.
    Academic Emergency Medicine 11/2014; 21(11):1203-1211.
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    ABSTRACT: Tricyclic antidepressants (TCAs) are highly lipophilic medications used to treat posttraumatic stress disorder and chronic pain. Intravenous lipid emulsion (ILE) is a recent antidote for lipophilic drug overdose with unclear effectiveness. ILE has been studied in TCA overdose in small animals, and cases are reported in humans, but controlled studies in a larger animal model are lacking. Given the high lipophilicity of amitriptyline, a TCA, the hypothesis was that ILE would be more effective than the standard antidote sodium bicarbonate in improving amitriptyline-induced hypotension. The objective was to determine if ILE improved hypotension (defined by a mean arterial pressure [MAP] < 60% baseline) compared to sodium bicarbonate for amitriptyline overdose in a critically ill porcine model.
    Academic Emergency Medicine 11/2014; 21(11):1212-1219.
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    ABSTRACT: Helicopter emergency medical services (EMS) transport is expensive, and previous work has shown that cost-effective use of this resource is dependent on the proportion of minor injuries flown. To understand how overtriage to helicopter EMS versus ground EMS can be reduced, it is important to understand factors associated with helicopter transport of patients with minor injuries.
    Academic Emergency Medicine 11/2014; 21(11):1232-1239.
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    ABSTRACT: The objective of this study was to calculate national estimates of depression-related emergency department (ED) visits and associated health care resource use among children and adolescents 17 years or younger. Another goal was to explore the effects of certain sociodemographic and health care system factors and comorbidities on ED charges and subsequent hospitalization in the United States.
    Academic Emergency Medicine 09/2014; 21(9):1003-1014.
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    ABSTRACT: Deep vein thrombosis (DVT) is both common and serious, yet the desire to never miss the diagnosis, coupled with the low specificity of D-dimer testing, results in high imaging rates, return visits, and empirical anticoagulation. The objective of this study was to evaluate a new approach incorporating bedside limited-compression ultrasound (LC US) by emergency physicians (EPs) into the workup strategy for DVT.
    Academic Emergency Medicine 09/2014; 21(9):971-980.
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    ABSTRACT: Due to the scarcity of specialized resources for pediatric trauma, "regionalization," or a system designed to get "the right child, to the right place, at the right time," is vital to quality pediatric trauma care. In Northern California, four pediatric trauma centers serve 3.9 million children within a geographically diverse area of 113,630 square miles. A significant proportion of children with trauma is initially triaged to nontrauma hospitals and may require subsequent transfer to a specialty center. Trauma transfer patterns to a pediatric trauma center may provide insight into regional primary triage practices. Transfers from hospitals in close proximity to pediatric trauma centers might suggest that some children could have avoided transfer with minimal additional transport time. While pediatric trauma centers are scarce and serve as regional resources, transfers from beyond the regular catchment area of a trauma center could be an indication of clinical need.
    Academic Emergency Medicine 09/2014; 21(9):1023-1030.
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    ABSTRACT: The objective was to evaluate the diagnostic test characteristics of three validated electrocardiographic (ECG) criteria for the diagnosis of left ventricular hypertrophy (LVH) in undifferentiated, asymptomatic emergency department (ED) patients with hypertension (HTN).
    Academic Emergency Medicine 09/2014; 21(9):996-1002.
  • Article: Go team!
    Academic Emergency Medicine 07/2014; 21(7):831-2.
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    ABSTRACT: The objectives were to examine how emergency medicine (EM) residents learn to care for patients in the emergency department (ED) who are homeless and how providing care for patients who are homeless influences residents' education and professional development as emergency physicians. Se llevaron a cabo entrevistas en profundidad y de forma individual con los residentes de MUE de dos programas. Se seleccionó una muestra aleatoria de residentes estratificada por el año de formación de cada lugar. Las entrevistas se grabaron digitalmente y se transcribieron profesionalmente. Un equipo de investigadores con experiencia diversa sobre contenidos relevantes revisó las transcripciones de forma independiente y aplicó la codificación a los fragmentos de texto usando una aproximación a la teoría fundamentada. El equipo se reunió regularmente para conciliar las diferencias en las interpretaciones de codificación. La obtención y el análisis de los datos ocurrió de forma iterativa, y las entrevistas continuaron hasta que se alcanzó la saturación teórica. Tres temas recurrentes emergieron de las entrevistas a los 23 residentes. En primer lugar, los residentes aprenden aspectos únicos de la MUE mediante la atención de los pacientes indigentes. Este aprendizaje incluye tanto los conocimientos específicos y las habilidades (por ejemplo, los procesos patológicos vistos infrecuentemente en otras poblaciones), como el desarrollo profesional como (por ejemplo, el valor principal de la asistencia en MUE). En segundo lugar, los residentes aprenden cómo atender a los pacientes indigentes a través de la experiencia y la enseñanza informal más que a través de un plan oficial de formación. Los residentes señalaron que existe poco tiempo en el plan de formación oficial dedicado a la indigencia, y que en su lugar aprenden durante las guardias asistenciales a través de la experiencia personal y la observación de los médicos con mayor experiencia. Un método único de aprendizaje fue a través de historias de “errores”, en las que los pacientes indigentes tuvieron malos resultados. En tercer lugar, la atención de los pacientes indigentes afecta emocionalmente a los residentes de forma compleja y en múltiples facetas. Las emociones fueron dominadas por sentimientos de frustración. Esta frustración se relacionó a menudo con sentimientos de inutilidad para ayudar verdaderamente a los pacientes indigentes, particularmente a los pacientes que acudieron con frecuencia al SU y que además tuvieron dependencia de alcohol. La atención de los pacientes indigentes en el SU es una parte importante de la formación de la residencia de MUE. Nuestros resultados indican la necesidad de aumentar el tiempo en el plan oficial de formación dedicado a los retos médicos y sociales únicos inherentes del tratamiento de pacientes indigentes, así como mayor apoyo y recursos para mejorar la capacidad de los residentes para atender a esta población vulnerable. Se requiere investigación adicional para determinar si estas intervenciones mejoran la formación del residente de MUE y, en última instancia, resultan en una mejor atención para los pacientes indigentes en el SU. Spanish Examinar cómo los residentes de medicina de urgencias y emergencias (MUE) aprenden a atender a los pacientes indigentes en el servicio de urgencias (SU), y cómo la atención a los pacientes indigentes influye en la educación y el desarrollo profesional de los residentes como urgenciólogos.
    Academic Emergency Medicine 06/2014; 21(6).