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PEM Pearls: To Scan or Not to Scan? CT Abdomen in Children with Blunt Torso Trauma

blunt torso traumaAn 18-month-old female with no past medical history is brought in by ambulance after a motor vehicle collision (MVC) at highway speed, restrained in an appropriate car seat. Mom was also brought in after delayed extrication with an obvious femur deformity. EMS reports that the patient had emesis on the scene, was fearful but calm, and has been moving all extremities.

Vitals per EMS: HR 120, BP 100/60, RR 30, SpO2 99%, Temp 36.5 C

Initial Exam:

  • General: crying
  • Neuro: Glasgow Coma Scale (GCS) of 13 (eyes shut unless talked to, crying spontaneously, moving all extremities)
  • MSK: atraumatic chest, erythema on the left leg
  • Abdomen: without tenderness

Blunt Torso/Abdominal Trauma

An intra-abdominal injury (IAI) is considered to be any radiographically or surgically apparent injury to an intra-abdominal structure (urinary tract, gastrointestinal tract, spleen, liver, pancreas, gallbladder, adrenal gland, vasculature, and fascia). An intra-abdominal injury requiring intervention (IAI-I) is any IAI that causes death or requires an intervention such as laparotomy, angiographic embolization, blood transfusion, or even admission for intravenous fluids [1].

Despite our curiosity and desire to diagnose all injuries, emergency medicine teams must focus on recognizing IAI-I and tailor their workup accordingly given the negative consequences of excessive workup and treatment of stable IAIs (e.g., unnecessary splenectomies, hepatectomies, increased length of stay, radiation, and increased medical costs/resources).

Although the incidence of pediatric blunt torso trauma in the United States was 110,525 cases in 2016, the prevalence of IAI has been quoted to be as low as 6.3%; more importantly, the prevalence of IAI-I is less than 2% [1]. Non-pediatric level 1 trauma centers were more likely to use computed tomography (CT) in pediatric trauma patients compared to pediatric trauma centers, even after adjusting for injury severity [2].

Clinical Decision Rule

The Pediatric Emergency Care Applied Research Network (PECARN) conducted a prospective study of over 12,000 children ages 0-18 years presenting to pediatric and general EDs with blunt torso trauma. Significant predictors of IAI-I were low GCS, abdominal tenderness, abdominal wall trauma, thoracic wall trauma, decreased breath sounds, and vomiting. The authors developed a prediction rule with a sensitivity of 97% (93.7, 98.9) and a negative predictive value of 99.9% (99.7, 1.00) [1]. External validation had similar sensitivity (99% 96-100%) reinforcing the utility of this clinical decision rule (CDR) in identifying low-risk individuals and decrease the use of CT [4].

In comparison to other CDRs, this rule does not include a gestalt variable but outperforms clinical gestalt with a lower miss rate (6 compared to 23) [5]. Of note, this prediction rule is not a two-way tool and was created only to determine individuals at low risk of IAI-I, rather than to assist providers in deciding who needs a CT scan.

IAI

Adapted from Holmes JF et al 2013 [1]

Reviewing the cases missed by the prediction rule in the initial study, possible clinical findings that could be captured with adjuncts, such as labs and imaging, include:

  • Gross hematuria
  • Microscopic hematuria (Red Blood Cells on Urinalysis)
  • Elevated AST/ALT
  • Rib fracture

Adjuncts

No single test effectively screens for IAI-I or IAI, but additional testing can increase the index of concern in cases that already have a higher pre-test probability (individuals who have any of the variables factored into the prediction rule). The following adjuncts can be considered for children who are not deemed very low risk.

Labs

  • Hematocrit <30% [3,7-8]
  • AST>200 U/L, ALT>125U/L [3,7, 9-10]
  • Lipase >100 U/L [9,11-12]
  • UA Gross hematuria [12-17]

Focused Assessment with Sonography for Trauma (FAST)

  • The diagnostic role of a FAST in pediatric trauma is less established than in adult trauma [18].
  • Application of FAST increases as provider suspicion for IAI increases [19].
  • As an adjunct to the clinical exam, FAST can be incorporated into decision making for selected cases of increased IAI concern [20].

Chest X-ray (CXR)

  • Injuries noted on a CXR may contribute to increased concern for IAI depending on location, mechanism, and type of injury [21].

Review of Case

Returning to our case, findings of concern include her GCS of 13 and reported emesis. Although it was a high-speed MVC and may represent a more severe mechanism, this variable was not found to be a predictor of IAI-I and should not in isolation inform your evaluation of her abdominal injury.

Application of the PECARN CDR demonstrates that the patient is not at very low risk for IAI-I. Labs and a FAST are performed and medications are given for symptom control.

The patient’s results are:

Labs:

  • HCT 35%
  • Lipase 20 U/L
  • AST 23 U/L, ALT 30 U/L
  • UA: no gross hematuria

FAST: Negative

On re-evaluation after ondansetron and acetaminophen, the patient has a GCS of 15 and is excitedly playing with her new teddy bear from the fire department while sipping apple juice. The patient is safely discharged home with her dad after a very frightening experience without unnecessary costs or radiation.

Take-Home Points

  • While blunt pediatric abdominal trauma has a high incidence, the prevalence of IAI-I is rather low.
  • The PECARN prediction rule for blunt torso trauma can identify patients that are very-low-risk for an IAI-I.
  • Notably, the mechanism of injury is not a predictable factor in determining IAI-I.
  • Clinicians should consider the use of labs, FAST, and CXR for risk stratification of patients that are not found to be very-low-risk.

Read more pediatric emergency medicine topics as part of the PEM Pearls Series on ALiEM.

References

  1. Holmes JF, Lillis K, Monroe D, et al. Identifying children at very low risk of clinically important blunt abdominal injuries. Ann Emerg Med. 2013;62(2):107-116.e2. doi:10.1016/j.annemergmed.2012.11.009. PMID: 23375510
  2. Marin JR, Wang L, Winger DG, Mannix RC. Variation in Computed Tomography Imaging for Pediatric Injury-Related Emergency Visits. J Pediatr. 2015 Oct;167(4):897-904.e3. doi: 10.1016/j.jpeds.2015.06.052. PMID: 26233603
  3. Holmes JF, Sokolove PE, Brant WE, et al. Identification of children with intra-abdominal injuries after blunt trauma. Ann Emerg Med. 2002;39(5):500-509. doi:10.1067/mem.2002.122900. PMID: 11973557
  4. Springer E, Frazier SB, Arnold DH, Vukovic AA. External validation of a clinical prediction rule for very low risk pediatric blunt abdominal trauma. Am J Emerg Med. 2019 Sep;37(9):1643-1648. doi: 10.1016/j.ajem.2018.11.031. PMID: 30502218.
  5. Mahajan P, Kuppermann N, Tunik M, et al. Comparison of Clinician Suspicion Versus a Clinical Prediction Rule in Identifying Children at Risk for Intra-abdominal Injuries After Blunt Torso Trauma. Acad Emerg Med. 2015;22(9):1034-1041. doi:10.1111/acem.12739. PMID: 26302354
  6. Nishijima DK, Yang Z, Clark JA, Kuppermann N, Holmes JF, Melnikow J. A cost-effectiveness analysis comparing a clinical decision rule versus usual care to risk stratify children for intraabdominal injury after blunt torso trauma. Acad Emerg Med. 2013;20(11):1131-1138. doi:10.1111/acem.12251. PMID: 24238315
  7. Taylor GA, Eichelberger MR, O’Donnell R, Bowman L. Indications for computed tomography in children with blunt abdominal trauma [published correction appears in Ann Surg 1992 Jul;216(1):99]. Ann Surg. 1991;213(3):212-218. doi:10.1097/00000658-199103000-00005. PMID: 1998402
  8. Taylor GA, O’Donnell R, Sivit CJ, Eichelberger MR. Abdominal injury score: a clinical score for the assignment of risk in children after blunt trauma. Radiology. 1994;190(3):689-694. doi:10.1148/radiology.190.3.8115612. PMID: 8115612
  9. Streck CJ, Vogel AM, Zhang J, et al. Identifying Children at Very Low Risk for Blunt Intra-Abdominal Injury in Whom CT of the Abdomen Can Be Avoided Safely. J Am Coll Surg. 2017;224(4):449-458.e3. doi:10.1016/j.jamcollsurg.2016.12.041. PMID: 28130170
  10. Streck CJ Jr, Jewett BM, Wahlquist AH, Gutierrez PS, Russell WS. Evaluation for intra-abdominal injury in children after blunt torso trauma: can we reduce unnecessary abdominal computed tomography by utilizing a clinical prediction model?. J Trauma Acute Care Surg. 2012;73(2):371-376. doi:10.1097/TA.0b013e31825840ab. PMID: 22846942
  11. Adamson WT, Hebra A, Thomas PB, Wagstaff P, Tagge EP, Othersen HB. Serum amylase and lipase alone are not cost-effective screening methods for pediatric pancreatic trauma. J Pediatr Surg. 2003;38(3):354-357. doi:10.1053/jpsu.2003.50107. PMID: 12632348
  12. Capraro AJ, Mooney D, Waltzman ML. The use of routine laboratory studies as screening tools in pediatric abdominal trauma. Pediatr Emerg Care. 2006;22(7):480-484. doi:10.1097/01.pec.0000227381.61390.d7. PMID: 16871106
  13. Mee SL, McAninch JW, Robinson AL, Auerbach PS, Carroll PR. Radiographic assessment of renal trauma: a 10-year prospective study of patient selection. J Urol. 1989;141(5):1095-1098. doi:10.1016/s0022-5347(17)41180-3. PMID: 2709493
  14. Morey, Allen F., et al. “Efficacy of Radiographic Imaging in Pediatric Blunt Renal Trauma.” Journal of Urology, vol. 156, no. 6, 1996, pp. 2014–2018., doi:10.1016/s0022-5347(01)65422-3.
  15. Brown SL, Haas C, Dinchman KH, Elder JS, Spirnak JP. Radiologic evaluation of pediatric blunt renal trauma in patients with microscopic hematuria. World J Surg. 2001;25(12):1557-1560. doi:10.1007/s00268-001-0149-6. PMID: 11775191
  16. Santucci RA, Langenburg SE, Zachareas MJ. Traumatic hematuria in children can be evaluated as in adults. J Urol. 2004;171(2 Pt 1):822-825. doi:10.1097/01.ju.0000108843.84303.a6. PMID: 14713834
  17. Levy JB, Baskin LS, Ewalt DH, et al. Nonoperative management of blunt pediatric major renal trauma. Urology. 1993;42(4):418-424. doi:10.1016/0090-4295(93)90373-i. PMID: 8212441
  18. Holmes JF, Gladman A, Chang CH. Performance of abdominal ultrasonography in pediatric blunt trauma patients: a meta-analysis. J Pediatr Surg. 2007 Sep;42(9):1588-94. doi: 10.1016/j.jpedsurg.2007.04.023. PMID: 17848254
  19. Menaker J, Blumberg S, Wisner DH, et al. Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma. J Trauma Acute Care Surg. 2014;77(3):427-432. doi:10.1097/TA.0000000000000296. PMID: 25159246
  20. Retzlaff T, Hirsch W, Till H, Rolle U. Is sonography reliable for the diagnosis of pediatric blunt abdominal trauma? J Pediatr Surg. 2010 May;45(5):912-5. doi: 10.1016/j.jpedsurg.2010.02.020. PMID: 20438925
  21. Holmes JF, Sokolove PE, Brant WE, Kuppermann N. A clinical decision rule for identifying children with thoracic injuries after blunt torso trauma. Ann Emerg Med. 2002 May;39(5):492-9. doi: 10.1067/mem.2002.122901. PMID: 11973556

Read more pediatric emergency medicine topics as part of the PEM Pearls Series on ALiEM.

By |2022-09-25T00:08:13-07:00Jan 29, 2021|Academic, Emergency Medicine, Pediatrics, PEM Pearls, Trauma|
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SplintER Series: “Pop in the Posterior Thigh”

transverse view of the hamstring

A 20-year-old male presents with right posterior thigh pain and difficulty walking after he felt a “pop” while sprinting in a race. An ultrasound of the right posterior thigh is performed and the above image is seen on the transverse view without compression (Image 1. ST- semitendinosus; BF – bicep femoris; H – hematoma. Courtesy of Matthew Negaard, MD).

 

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By |2021-01-24T03:13:30-08:00Jan 27, 2021|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|
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SAEM Clinical Image Series: The Insidious Rash

rash

A 60-year-old African American female with a history of hypertension presents to the emergency department for an itchy, diffuse rash. She first noticed the lesions a few years prior, and they have progressively become larger and more inflamed. The lesions have become severely pruritic over the last couple of months. Steroid creams did not appear to improve symptoms. Currently, the lesions on her arm have become painful with yellow drainage. The patient denies nausea, vomiting, and fever.

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By |2021-01-20T20:01:42-08:00Jan 25, 2021|Academic, Dermatology, Emergency Medicine, Heme-Oncology, SAEM Clinical Images|
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2020 ACLS Guidelines on Medications for Toxicology-Related Conditions

ACLS 2020 toxicology

The 2020 ACLS guidelines provide recommendations on the medication-specific management recommendations for toxicology [1]. Although the name of the guidelines emphasize they are ‘Advanced,’ these are still relatively basic toxicology recommendations and largely apply to patients in cardiac arrest or refractory shock. There are also our 2020 ACLS guideline summaries on vasopressor and non-vasopressor medications used during cardiac arrest and arrhythmia management.

Benzodiazepines

  • Flumazenil if NOT recommended in undifferentiated coma (COR3, LOE B-R)

Cocaine

  • Benzodiazepines, alpha blockers, calcium channel blockers, nitroglycerin, and/or morphine can be beneficial for hypertension, tachycardia, agitation, or chest discomfort (COR 2a, LOE B-NR)
  • Pure beta-adrenergic blockers may be reasonable to avoid, although “contradictory evidence exists (COR 2b, LOE C-LD)

Local Anesthetics

  • IV lipid emulsion may be reasonable (COR 2b, LOE C-LD)

Sodium Channel Blockers (e.g. tricyclic antidepressants)

  • Sodium bicarbonate can be beneficial for cardiac arrest or life-threatening conduction delays, such as QRS >120 msec (COR 2a, LOE C-LD)
  • Extracorporeal membrane oxygenation (ECMO) may be considered for cardiac arrest or refractory shock (COR 2b, LOE C-LD)

Digoxin

  • Antidigoxin Fab should be administered in severe toxicity (COR 2b, LOE B-R)

Carbon Monoxide

  • Hyperbaric oxygen may be helpful in severe toxicity (COR 2b, LOE B-R)

Cyanide

  • Hydroxocobalamin can be beneficial, along with oxygen +/- sodium thiosulfate (COR 2a, LOE C-LD)

Atrioventricular Nodal Blockers

Intervention Beta-adrenergic blocker Calcium channel blocker Evidence (COR/LOE)
High-dose insulin Reasonable Reasonable 2a/C-LD
Glucagon IV Reasonable May be considered 2a/C-LD and 2b/C-LD
Calcium May be considered Reasonable 2b/C-LD and 2a/C-LD
ECMO Might be considered Might be considered 2b/C-LD

Table: Medications and interventions in the management of beta-adrenergic and calcium channel blocker toxicity (COR: class of recommendation, LOE: level of evidence, ECMO: extracorporeal membrane oxygenation)

Reference

Panchal AR, Bartos JA, Cabañas JG, et al; Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020 Oct 20;142(16_suppl_2):S366-S468. doi: 10.1161/CIR.0000000000000916. Epub 2020 Oct 21. PMID: 33081529.
By |2026-06-16T16:16:51-07:00Jan 23, 2021|Critical Care/ Resus, EM Pharmacy Pearls, Tox & Medications|
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2020 ACLS Guidelines on Medications for Management of Specific Arrhythmias

ACLS 2020 arrhythmias

The 2020 ACLS guidelines provide recommendations on the medication-specific management for arrhythmias including wide-complex tachycardia, regular narrow-complex tachycardia, atrial fibrillation/flutter, and bradycardia [1]. There are also our 2020 ACLS guideline summaries on vasopressor and non-vasopressor medications used during cardiac arrest and toxicology-related conditions.

Wide-complex tachycardia (WCT)

Wide-complex tachycardia Medication(s) Evidence
Hemodynamically stable Adenosine COR 2b, LOE B-NR
Amiodarone, procainamide, or sotalol COR 2b, LOE B-R
NOTE: Verapamil is harmful COR 3, LOE B-NR
Polymorphic VT with long QT (torsades de points) Magnesium COR 2b, LOE C-LD
Polymorphic VT without long QT Lidocaine or amiodarone COR 2b, LOE C-LD

Regular narrow-complex tachycardia

  1. Vagal maneuvers (COR 1, LOE B-R)
  2. Adenosine (COR 1, LOE B-R)
  3. Diltiazem or verapamil (COR 2a, LOE B-R)
  4. Beta-blockers (COR 2a, LOE C-LD)

Atrial fibrillation/flutter with rapid ventricular rate

  1. Beta-blocker or diltiazem or verapamil (COR 1, LOE B-NR)
  2. Amiodarone (COR 2a, LOE B-NR)

Note that medications can be harmful in these settings:

  1. Preexcitation: Digoxin, non-dihydropyridine calcium channel blockers, beta-blockers, or amiodarone (COR 3, LOE C-LD)
  2. LV systolic dysfunction and decompensated heart failure: Non-dihydropyridine calcium channel blockers or beta-blockers (COR 3, LOE C-EO)

Bradycardia

  1. Treat reversible causes (COE 1, LOE C-EO)
  2. Atropine if hemodynamic compromise (COR 2a, LOE B-NR)
  3. Epinephrine or transcutaneous pacing if unresponsive to atropine (COR 2b, LOE C-LD)

Reference

Panchal AR, Bartos JA, Cabañas JG, et al; Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020 Oct 20;142(16_suppl_2):S366-S468. doi: 10.1161/CIR.0000000000000916. Epub 2020 Oct 21. PMID: 33081529.

By |2021-01-20T14:10:34-08:00Jan 23, 2021|Cardiovascular, Critical Care/ Resus, EM Pharmacy Pearls, Tox & Medications|
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2020 ACLS Guidelines on Vasopressors and Non-Vasopressors During Cardiac Arrest

The 2020 ACLS Guidelines were published in October 2020 [1]. This first of 3 blog posts will focus on vasopressor and non-vasopressor medications during cardiac arrest. Part 2 will focus on specific arrhythmia management and Part 3 will focus on toxicologic interventions.

Summary

There were no major updates for vasopressors and non-vasopressors used during cardiac arrest. The American Heart Association (AHA) published Highlights of the 2020 Guidelines [PDF] as a clear and concise summary. Now that the AHA is releasing focused updates in the 5-year period between guidelines (like this one on lidocaine), fewer major changes likely will be needed when the full guidelines are published.

 

Vasopressor Non-Vasopressor

Epinephrine

  • Recommended for patients in cardiac arrest (COR 1, LOE B-R)
  • Reasonable to administer 1 mg every 3-5 minute (COR 2a, LOE B-R)
  • Reasonable to administer as soon as feasible in non-shockable rhythm (COR 2a, LOE C-LD)
  • May be reasonable to administer after initial defibrillation attempts have failed in shockable rhythm (COR 2b, LOE C-LD)

Amiodarone or lidocaine

  • May be considered for VF/pVT unresponsive to defibrillation (COR 2b, LOE B-R)

 

 

 

Vasopressin

  • Offers no advantage over epinephrine (COR 2b, LOE C-LD)

Steroids

  • During CPR, are of uncertain benefit in OHCA (COR 2b, LOE C-LD)
 

Calcium

  • Routine use NOT recommended (COR 3, LOE B-NR)
 

Sodium bicarbonate

  • Routine use NOT recommended (COR 3)
 

Magnesium

  • Routine use NOT recommended (LOE B-R)

Table: Vasopressors and non-vasopressors used during cardiac arrest (VF: ventricular fibrillation, pVT: pulseless ventricular tachycardia)

 

Reference:

Panchal AR, Bartos JA, Cabañas JG, et al; Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020 Oct 20;142(16_suppl_2):S366-S468. doi: 10.1161/CIR.0000000000000916. Epub 2020 Oct 21. PMID: 33081529.

By |2021-01-20T13:44:43-08:00Jan 23, 2021|Critical Care/ Resus, EM Pharmacy Pearls, Tox & Medications|
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Social Medicine in the Emergency Department: Not all conditions can be treated with medicines

social medicine emergency department homeless

On the day we met Jane, a woman in her 70’s with diabetes and mobility impairment, she was visiting an Emergency Department (ED) for the 50th time in the past year. Jane was experiencing homelessness and spent much of her day riding public transportation in her wheelchair. Bystanders, often concerned for her health after noticing she had an episode of incontinence, would call 911 after which Jane would be brought to the nearest ED.

On the day Jane came to our ED, our multidisciplinary ED-based Social Medicine team was asked to help in her care. She was very thin, her clothes were wet from rain, and her belongings were falling from the plastic bags draped on the back of her wheelchair.  Our team sat with Jane to understand what type of help that she wanted — she was hungry, she hadn’t had stable access to food for months, and her bottom was painful as she had developed wounds from spending hours sitting in soiled clothes. That day, our team provided her with a sandwich and hot coffee, brought her a set of clean, dry clothes, and built enough rapport with her to interest her in moving indoors to a nearby respite center. Over the ensuing months, Jane gained back her strength, she established care with a primary care physician and improved her diabetes control, her wounds healed, and she built a relationship with a case manager who helped her to move into long-term housing. And, as a secondary outcome, her use of acute care services dropped substantially – she had less than 5 ED visits and no hospitalizations in the following year.  Caring for Jane and watching what happened next was a lesson for all of us about the impact of addressing medical and social needs together.

What is an ED Social Medicine team?

We formed the ED Social Medicine team in 2017 to support ED clinicians and help better meet the complex medical, behavioral health, and social needs of ED patients. A brief description of our work was recently published in JAMA [1], which provides one potential roadmap to medical and social care integration in the ED. A few core components of this work include:

  1. Asking patients about their self-identified social needs – Meeting a patient’s psychosocial needs allows them to better engage with medical care.
  2. Supporting ED clinicians in the care of patients with complex behavioral health and social needs – The ED and acute care system cannot function optimally in a silo. The Social Medicine team is multi-disciplinary and includes hospital-based social workers, nurses, pharmacists, care coordinators, AND strong partnerships with ambulatory health care clinicians and community-based organizations essential to the safe discharge and successful care of ED patients with complex social needs.
  3. Considering how to best promote the individual patient’s health and independence while preserving access to acute care for all patients – Medical, social, and behavioral health resources in the community are often more robust than we might realize; clinicians and patients both win by better understanding the landscape of care and resources available in the community. Leveraging available community resources also allows the ED and inpatient hospital to be preserved for patients with the most emergent medical conditions.

Integrating the medical, behavioral, and social care for your patient

Treatment of medical conditions without consideration of underlying social needs will be less effective, more costly, and may lead to moral distress for both patients and providers. We all want to feel that we are treating the patient so that they will do as well as possible in their life outside the hospital — to address not just the immediate medical issue, but the things that are fundamental challenges in their lives.

For instance, when we are treating a patient in the ED with diabetes, homelessness, and social isolation, prescribing medication to treat hyperglycemia may be the most straightforward solution, but it is unlikely to be maximally effective without ensuring the patient can do the following:

  • Afford the medication
  • Get to the pharmacy
  • Read the label and administer the medication
  • Access affordable food
  • Obtain transportation to follow up medical appointments
  • Find a stable place to live
  • Connect with social support in their community

These can seem daunting, and it may not be possible to improve all of these issues during the ED visit, but there are effective interventions to try to help patients experiencing complex social needs. As related to the example above:

  • Arrange a conversation with a social worker to assess and address the patient’s social needs
  • Dispense discharge medications directly from the ED
  • Ask the pharmacist to consider how to make dosing easier such as a medi-set or special labeling for patients who speak a primary language other than English, or have visual impairment or low literacy
  • Facilitate the next check up in primary care or other medical care by making an appointment or providing a warm handoff
  • Provide printed information about social and community resources such as meal kitchens, food pantries, housing programs and community groups (such as support groups, faith communities and cultural organizations)

No matter what the problem, a first step is always to ask the patient what support they need in order to be successful.

Call to action for social medicine

  1. Partner up: We encourage you to understand the underlying social needs of your patients and work with partners, such as your ED social workers and community social services, to help meet those needs. The ED visit can be an opportunity to go beyond healthcare, and help our patients realize optimal health.
  2. Ask the patient: At the frontline, we recommend asking your patients about their primary concerns and social needs, and doing what you can to help.
  3. Form a team: If you want to go a step further, form a team and develop partnerships with staff in your ED (e.g., social workers) and outside your health setting (e.g., community based organizations) to understand a system problem (e.g., access to medications, food or emergency housing) more deeply. Talk to your patients to get their input and recommendations. Then, use quality improvement techniques to improve the care of that problem in service to your patients.
  4. Look upstream: If you want to work upstream of direct care, join or form a group to understand a problem at the community level and advocate for increased social services available to your organization and community.

More resources

If you want to learn more or get more involved in the Social Emergency Medicine space:

 

References

  1. Chase J, Bilinski J, Kanzaria HK. Caring for Emergency Department Patients With Complex Medical, Behavioral Health, and Social Needs. JAMA. 2020;324(24):2550-2551. doi:10.1001/jama.2020.17017

Photo by Ev on Unsplash

By |2026-06-16T16:16:49-07:00Jan 22, 2021|Beyond the Abstract, Emergency Medicine|
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