Annals of Emergency Medicine RSS feed: Current Issue. Scope and Stature of the Journal Annals of Emergency Medicine , the official journal of the American College of Emergency Physicians, is an international, peer-reviewed journal dedicated to improving the quality of care by publishing the highest quality science for emergency medicine and related medical specialties. Annals publishes original research, clinical reports, opinion, and educational information related to the practice, teaching, and research of emergency medicine. In addition to general emergency medicine topics, Annals regularly publishes articles on out-of-hospital emergency medical services, pediatric emergency medicine, injury and disease prevention, health policy and ethics, disaster management, toxicology, and related topics. The journal welcomes submissions from international contributors and researchers of all specialties. Annals continues to be the largest circulation peer review journal in emergency medicine (over 28,000 subscribers, several times its nearest competitor). It is also one of the most accessible to non-subscribing readers, since over 1,786 medical school and hospital libraries subscribe to it in print and 5,372 institutions include Annals in their online licenses for ScienceDirect (the world's largest electronic collection of science, technology and medicine full text and bibliographic information). ScienceDirect was utilized for access to Annals articles approximately 429,000 times last year, a 37% increase from the prior year. Annals is also available on the Web (with full text of all articles dating back to its inception), where it received over 828,000 page views (about twice the previous year). More than 47,800 reprint requests were ordered last year. Annals is the emergency medicine journal most frequently cited by authors. In 2007 Annals again increased its impact factor (average citation rate per article); over the past 10 years Annals has averaged an increase in impact factor more than 4 times greater than the average for all medical journals combined. Among 6,417 science and medical journals in the Science Citation Index, Annals ranked in the top 12% by citation frequency and the top 12% by impact factor. Annals continues to have the highest impact factor of all 11 emergency medicine/resuscitation journals tracked by SCI, but has further increased the size of its lead over its nearest competitor this year (37%). In the past 5 years, 1,224 different journals in the ISI science journal database cited an article in Annals. In a typical year, Annals articles are cited by over 400 different scientific journals, most of them from a broad range of specialties outside of emergency medicine. Annals , of course, is also the journal most frequently cited by other emergency medicine journals. Annals articles also generate considerable interest in the lay media, with approximately 620 hits in print, radio and television, not including audio news releases. Major outlets included the New York Times , the Wall St. Journal , National Public Radio, the Washington Post , the Los Angeles Times , USA Today , Modern Healthcare , Reuters, Associated Press and CNN, as well as many trade publications. We distributed two audio news releases about Annals studies to radio stations around the country. One on rising rates of elderly patients in the emergency department (study author Mary Pat McKay, MD, MPH) was aired 4,798 times on radio stations around the country and reached 20 million listeners. Another audio news release on low rates of reimbursement for Medicaid patients (study author Renee Hsia, MD, MSc) was aired 4,019 times on radio stations and reached 10 million listeners. Annals is an international journal; half of the full text articles accessed via ScienceDirect were downloaded by readers in 79 countries outside the U.S. Our contributors are also international in scope; in 2008 submissions came to us from 39 different countries, with 36% of submissions originating outside the United States, and 19% originating outside North America and Western Europe. Asia and Europe each contributed 15%, and the Middle East 2%. The largest volume other than the U.S. was submitted from Taiwan, Turkey, Canada, France, United Kingdom, Korea, Netherlands, and Australia, in descending order. But the list also includes Brazil, Thailand, Mexico, Tunisia, Georgia, Finland, and Bulgaria. Annals of Emergency Medicine is ranked 1 st of 12 in the Emergency Medicine category on the 2008 Journal Citation Reports®, published by Thomson Reuters. http://www.annemergmed.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Annals of Emergency Medicine0196-0644531January 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.annemergmed.com/article/PIIS0196064408019719/abstract?rss=yesThe National Report Card on the State of Emergency Medicine10.1016/j.annemergmed.2008.10.027Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9The National Report Card on the State of Emergency Medicine11http://www.annemergmed.com/article/PIIS0196064408019720/abstract?rss=yesThe National Report Card on the State of Emergency Medicine10.1016/j.annemergmed.2008.10.026Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9The National Report Card on the State of Emergency Medicine33http://www.annemergmed.com/article/PIIS0196064408019732/abstract?rss=yesACEP gratefully acknowledges the many organizations and government agencies listed in the appendix that previously published data that were instrumental in the creation of this report. ACEP particularly appreciates the valuable contribution of the State and Territorial Injury Prevention Directors Association for permitting the use of the results of injury prevention funding questions from its 2007 “State of the States” survey of injury prevention directors. Additionally, ACEP extends its sincere appreciation to state health officials throughout the country who responded to ACEP's survey questions, as well as to the volunteer leaders and staff of ACEP's chapters who provided meaningful input into the compilation of this report. Finally, ACEP wishes to thank Renee Schwalberg, Stacy Gleason, Jennifer Decker, Valerie Gwinner and the other staff at Altarum Institute for their invaluable assistance in the development and preparation of this report. Financial support for this research project was generously provided by the Emergency Medicine Foundation, made possible by a $250,000 grant from the WellPoint Foundation and a $50,000 grant from the Robert Wood Johnson Foundation.The National Report Card on the State of Emergency Medicine: Evaluating the Emergency Care Environment State by State 2009 EditionStephen K. Epstein, Jonathan L. Burstein, Randall B. Case, Angela F. Gardner, Sanford H. Herman, Jon Mark Hirshon, John W. Jermyn, Mary Pat McKay, James C. Mitchiner, William P. Sullivan, Mary Jo Wagner, Susan Beer, Laura Tiberi, Craig Price, Ron Cunningham, Dean Wilkerson, Marilyn Bromley, Marjorie Geist, Laura Gore, Cynthia A. Singh, Gordon Wheeler, Stacy F. Gleason, Jennifer Decker, Valerie M. Gwinner, Renee H. Schwalberg10.1016/j.annemergmed.2008.10.028Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9The National Report Card on the State of Emergency Medicine4148http://www.annemergmed.com/article/PIIS0196064408019781/abstract?rss=yes Emergency department (ED) crowding, boarding, and hospital diversion have been negatively associated with multiple patient care measures (time to antibiotics, analgesic administration, etc).The National Report Card on the State of Emergency Medicine: Evaluating the Emergency Care Environment State by State 2009 EditionBenjamin S. Heavrin, Tyler W. Barrett, Tyler W. Barrett, David L. Schriger10.1016/j.annemergmed.2008.11.001Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9Annals of Emergency Medicine Journal Club149150http://www.annemergmed.com/article/PIIS0196064408019835/abstract?rss=yes[Centers for Disease Control and Prevention. False-positive oral fluid rapid HIV tests—New York City, 2005-2008. MMWR Morb Mortal Wkly Rep. 2008;57:660-665.] The New York City Department of Health and Mental Hygiene (NYC DOHMH) operates 10 sexually transmitted disease (STD) walk-in clinics offering various free services, including confidential or anonymous testing for HIV. In January 2004, the STD clinics introduced on-site rapid HIV testing of fingerstick whole-blood specimens with the OraQuick brand test (OraSure Technologies, Bethlehem, PA). In March 2005, the clinics replaced fingerstick whole-blood testing with oral fluid testing with the OraQuick Advance Rapid HIV-1/2 Antibody Test. The clinics use Western blot confirmatory tests on serum to confirm all whole-blood or oral fluid reactive (ie, preliminary positive) rapid tests. In late 2005, an unexpected increase in the number of false-positive oral fluid tests occurred, but the increase subsided after several months. In December 2005, although the cluster of false-positive oral fluid test results was being investigated, the NYC DOHMH Bureau of STD Control suspended oral fluid testing in the clinics for 3 weeks and replaced it with fingerstick whole-blood rapid testing, which produced no false-positive test results. On December 21, 2005, NYC DOHMH resumed oral fluid rapid testing but also introduced the use of immediate follow-up fingerstick whole-blood testing, using a second OraQuick test, after any reactive oral fluid test result. In late 2007, another larger increase in the incidence of false-positive oral fluid rapid test results was observed. The cause for the episodic increases in false-positive oral fluid tests has not yet been determined. NYC DOHMH has again suspended the use of oral fluid testing in STD clinics, and fingerstick whole-blood testing is the only rapid HIV test being used in this setting. These findings underscore the importance of confirming all reactive HIV tests, both from oral fluid and whole-blood specimens. In addition, the results suggest that the NYC DOHMH strategy of following up reactive oral fluid test results with an immediate fingerstick whole-blood test reduced the number of apparent false-positive oral fluid test results and might be a useful strategy in other settings and locations.False-Positive Oral Fluid Rapid HIV Tests—New York City, 2005-2008Centers for Disease Control and Prevention10.1016/j.annemergmed.2008.11.003Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9Infectious Disease151154http://www.annemergmed.com/article/PIIS0196064408019847/abstract?rss=yes[Ann Emerg Med. 2008;53:154-156.] The 2006 CDC revised recommendations for HIV testing, which recommend HIV screening (ie, performing an HIV test for all patients in a defined population) in all health care settings, represented a major turning point in the national approach to combating the HIV epidemic. That policy shift has had a particularly significant influence on the emergency medicine community. Inclusion of emergency departments (EDs) in the CDC recommendations stems from compelling data demonstrating disproportionately high rates of unrecognized HIV infection in acute care settings. It has given way to financial investment (albeit relatively modest) from a variety of sources, including private foundations, city and state health departments, and most recently a $35 million CDC grant, a significant proportion of which has gone to fund screening initiatives in inner-city EDs throughout the United States.CommentaryRichard E. Rothman, Brian Kalish10.1016/j.annemergmed.2008.11.004Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9Infectious Disease154156http://www.annemergmed.com/article/PIIS0196064408013929/abstract?rss=yes[Ann Emerg Med. 2009;53:157.]“How's work?” my roommate asked me as he does every night. Seems like such a banal question. It's easy to ask, and rolls off the tongue well. For some people it comes out as part of a standard greeting. “Hi, how are things? How is work?”“How's Work?”Daniel S. Schwartz10.1016/j.annemergmed.2008.06.459Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9Change of Shift157157http://www.annemergmed.com/article/PIIS0196064408007944/abstract?rss=yesA 59-year-old right-handed professional painter presented to the emergency department with complaint of pain in the left hand. Approximately 2 hours before arrival, he was cleaning his high-pressure paint gun when it accidentally fired into his left palm. Physical examination revealed a small puncture wound at the distal palmar crease on the ulnar aspect of the left palm, with mild erythema and tenderness around the wound (). Scar and skin retraction at the base of the small and ring fingers was also observed, which the patient said was longstanding and unrelated to the acute injury. Radiograph of the left hand revealed no fracture or radiopaque foreign body. The left hand was splinted and elevated. Intravenous antibiotics, analgesics, and tetanus prophylaxis were given. Hand surgeon consultation was obtained and the patient underwent urgent exploration of the hand in the operating room.Male With Pain in Left HandBenjamin T. Brown, Nilton D. Medina, Lee E. Edstrom10.1016/j.annemergmed.2008.05.006Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9Images in Emergency Medicine158158http://www.annemergmed.com/article/PIIS0196064408007981/abstract?rss=yesA 49-year-old man sustained a crushing injury to the torso as a lawn tractor rolled over him while he was driving it up the ramp of a flatbed trailer. He was briefly apneic while pinned in a jack knife position. He appeared cyanotic over his face and neck with scattered petecchiae over his upper torso and face (). His examination also revealed bilateral subconjunctival hemorrhages (). He remained neurologically intact despite an anterior compression fracture of the L2 vertebral body.Male With Torso InjuryBenjamin M. Braslow, S. Peter Stawicki, Edward T. Dickinson10.1016/j.annemergmed.2008.05.010Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9Images in Emergency Medicine159159http://www.annemergmed.com/article/PIIS0196064408016338/abstract?rss=yesIn a retrospective review of 149 patients with subarachnoid hemorrhage, Byyny found relatively low sensitivity of CT for subarachnoid hemorrhage – overall sensitivity 93%, sensitivity 91% in patients with normal mental status and underlying vascular lesions. By contrast, 2 prospective series found sensitivities of 98% (119 patients with subarachnoid hemorrhage who had computed tomography [CT] within 12 hours of headache onset) and 100% (42 patients who had CT within 6 hours). Sensitivity Of Computed Tomography For Subarachnoid HemorrhageDavid T. Schwartz10.1016/j.annemergmed.2008.06.471Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9Correspondence160161http://www.annemergmed.com/article/PIIS0196064408016314/abstract?rss=yesI read with interest the article by Byyny et al on the sensitivity of computed tomography (CT) for subarachnoid hemorrhage. They concluded that modern CT cannot completely exclude subarachnoid hemorrhage and patients with negative imaging results “…must undergo further evaluation to exclude…lesions.” These findings reinforce subarachnoid hemorrhage as the diagnostic “perfect storm” where symptoms can present atypically, the gold standard involves a painful, time-consuming test (lumbar puncture), and if missed, may result in serious harm. How should we interpret these new findings? Should these results change our threshold to lumbar puncture patients with headache? Step back and think whether this study purports to answer these questions; I would assert it does not.The Answer to Imperfect Computed Tomography Sensitivity for Subarachnoid Hemorrhage: Use Clinical JudgmentJesse M. Pines10.1016/j.annemergmed.2008.06.472Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9Correspondence161162http://www.annemergmed.com/article/PIIS0196064408016326/abstract?rss=yesWe thank Dr. Schwartz for his comments about our article. We agree that emergency physicians should use a Bayesian approach to risk assessment; thereby including the patient's pretest probability of disease and the test characteristics to determine the patient's posttest disease probability. This posttest probability allows physicians to make a risk-benefit assessment of further testing and/or therapy and to have a well-informed conversation with their patients.In replyRichard L. Byyny, Larry J. Baraff, William R. Mower10.1016/j.annemergmed.2008.08.013Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9Correspondence162162http://www.annemergmed.com/article/PIIS0196064408016375/abstract?rss=yesWe are writing to present a case series cataloguing our experience with remifentanil as the sole agent for brief, painful procedures in the emergency department (ED). Although described as part of a combination technique, this is the first description of remifentanil as the sole agent for this purpose.Remifentanil for Procedural Sedation in the Emergency DepartmentW. James Phillips, John Halpin, Jonathan Jones, Kendall McKenzie10.1016/j.annemergmed.2008.08.011Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9Correspondence163163http://www.annemergmed.com/article/PIIS0196064408017290/abstract?rss=yesBirnbaum et al report in their validation study of the San Francisco Syncope Rule that 26% of patients with serious outcomes were not identified by the rule. They also report that physician judgment without application of the prediction rule resulted in admission of all 61 (100%) subjects who experienced serious outcomes. What we cannot glean from the article is how the clinicians formulated that judgment.Clinical Judgment, Clinical Decision Rules, and Evidence-Based Medicine: Thoughts on “An Observation of Failure to Validate the San Francisco Syncope Rule”Andrew Leifer10.1016/j.annemergmed.2008.08.037Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9Correspondence164164http://www.annemergmed.com/article/PIIS0196064408015825/abstract?rss=yesA contract is generally defined as an agreement between 2 or more parties creating obligations that are enforceable or otherwise recognizable at law. The simplicity of this definition is contrasted only by the reality that contracts frequently qualify for inclusion in the dark compendium of human misadventure. Contract Issues for Emergency Physicians helps physicians navigate through this darkness.Edward Monico10.1016/j.annemergmed.2008.07.045Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9Book and Media Reviews165165http://www.annemergmed.com/article/PIIS0196064408016612/abstract?rss=yesWhat started in 1991 as a simple reference with 12 chapters has now grown to include 77 chapters that are divided into 10 sections in the fourth edition of this book. This book is designed to assist the medical student from the initial decision to enter emergency medicine through the residency years and beyond. With the previously noted 77 chapters the text is broad in scope but occasionally superficial in content. For example, the book takes time to discuss disability insurance including the “own occupation” policy and the cost of living adjustment rider but life insurance is given only a cursory mention with no mention of even the 2 basic types available. At other times, it feels as if the obvious is being stated when advice is given to show up for a scheduled interview, be punctual, and know the basic details about the program prior to the interview day but as any residency director can attest this advice goes unheeded during each interview season.Mitch Charles10.1016/j.annemergmed.2008.08.024Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9Book and Media Reviews165166http://www.annemergmed.com/article/PIIS0196064408020969/abstract?rss=yesVIRGINIA, MARYLAND, WEST VIRGINIA – SHENANDOAH VALLEY: ATTENTION! EMERGENCY PHYSICIAN OPENING Democratic independent group wishes to add emergency physician to staff of 9. Rapid 18-month partnership track. 46k visit ED at Gateway to Shenandoah Valley, 70 miles west of Washington, DC/Baltimore on I-81 corridor. Rapidly growing area with healthy economy, low cost of living and easy access to both urban and outdoor activities. Supportive hospital staff. Very stable group and stable contract (68 years of combined local experience; enhanced automatically renewable 3-year contract). Contact Daryl LaRusso, MD, MPH, by phone (304-264-1287x1701), E-mail (dlarusso@cityhospital.org), or fax CV (304-264-1374).Classified10.1016/S0196-0644(08)02096-9Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9IBCIBChttp://www.annemergmed.com/article/PIIS019606440802026X/abstract?rss=yesTable of Contents10.1016/S0196-0644(08)02026-XAnnals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9FrontmatterA1A2http://www.annemergmed.com/article/PIIS0196064408020283/abstract?rss=yesEditors10.1016/S0196-0644(08)02028-3Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9FrontmatterA3A5http://www.annemergmed.com/article/PIIS0196064408020295/abstract?rss=yesUpcoming TOC10.1016/S0196-0644(08)02029-5Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9FrontmatterA6A6http://www.annemergmed.com/article/PIIS0196064408019793/abstract?rss=yesThree years after publishing a report card on the state of US emergency care the American College of Emergency Physicians (ACEP) has delivered a second edition. Both report cards carry the same overall grade, a C-, but the similarities end there. The new report takes a much more rigorous look at the state of emergency care, enough so to be published as a scientific paper in this issue of Annals.The 2009 ACEP Report Card, What it Says, What it Means and What it Might AccomplishEric Berger10.1016/j.annemergmed.2008.11.002Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9News and PerspectiveA7A9http://www.annemergmed.com/article/PIIS0196064408020064/abstract?rss=yesWhen Michael E. DeBakey, MD, died in July at the age of 99, more than one obituary described him as the greatest surgeon ever, emphasizing his path-breaking work in open-heart surgery, coronary bypasses, the artificial heart and heart-lung machine.Dr. Michael DeBakey's Contributions to Emergency Medicine and Trauma CareLee Cearnal10.1016/j.annemergmed.2008.11.006Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9News and PerspectiveA10A11http://www.annemergmed.com/article/PIIS0196064408020301/abstract?rss=yesMANUSCRIPT TITLE (PLEASE TYPE OR PRINT) _________________________________________________________________Manuscript Submission Agreement10.1016/S0196-0644(08)02030-1Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9News and PerspectiveA12A12http://www.annemergmed.com/article/PIIS0196064408020313/abstract?rss=yesAnnals of Emergency Medicine is the official publication of the American College of Emergency Physicians (www.acep.org). The journal is provided to all ACEP members as a membership benefit. For information about becoming an ACEP member, contact ACEP's member services department at the address below. For your convenience, a postage-paid card for obtaining membership information is included in every issue of the journal.Information for Readers10.1016/S0196-0644(08)02031-3Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9News and PerspectiveA13A13http://www.annemergmed.com/article/PIIS0196064408020921/abstract?rss=yesUCSF Dept of Emergency Medicine Educational Confernce Series. January 1-December 31, 2009. San Francisco, CA. Sponsor: UCSF. Fee: TBA. Contact: Michelle Lin, MD, 1001 Potrero Ave, Suite 1E21, SFGH Emergency Services, San Francisco, CA 94110. 415-206-5760. (336)Calendar10.1016/S0196-0644(08)02092-1Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9FrontmatterA17A32http://www.annemergmed.com/article/PIIS0196064408020945/abstract?rss=yesAds and complete payments must be received in writing by the issue’s deadline date. These deadlines apply to insertions, cancellations, and changes. Classified 2009 Advertising Rates & Information: New Value-Added Feature—Your Ad Online at no Additional Cost!10.1016/S0196-0644(08)02094-5Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9FrontmatterA34A34http://www.annemergmed.com/article/PIIS0196064408020957/abstract?rss=yesAd rates and deadlines, see page 34A. POSITIONS AVAILABLEClassified10.1016/S0196-0644(08)02095-7Annals of Emergency Medicine 53, 1 (2009)2009-01-01Annals of Emergency Medicine2009-01-01531S0196-0644(08)X0014-9FrontmatterA35A48