An Unusual Cause of Fever, Neck Pain, and Neck Stiffness: Acute Calcific Tendinitis of the Longus Colli Muscle.

BACKGROUND: Acute calcific tendinitis (ACT) of the longus colli muscle (LCM) is an inflammatory response due to deposition of calcium hydroxyapatite crystals. It is typically correlated with whiplash and overuse injuries. A common presentation of this inflammatory response is acute but progressive neck pain. It is a rare but important cause of neck pain that should be considered on a differential diagnosis when distinguishing between life-threatening conditions and non-life-threatening causes of neck pain. CASE REPORT: A 51-year-old woman presented to the emergency department (ED) reporting a mild sore throat that progressed to acute neck pain and stiffness. She also reported fatigue, fever, myalgias, and nausea. In the ED, the patient was tachycardic, hypertensive, and mildly febrile with normal oxygen saturation. Examination revealed meningismus and was negative for lymphadenopathy, oropharyngeal findings, and neurologic deficits. Laboratory studies were significant for leukocytosis. Computed tomography (CT) neck was obtained and was notable for calcification of the superior left longus colli muscle with prevertebral and retropharyngeal space edema along the muscle body. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ACT of the LCM is a benign, self-limited condition that can present with features overlapping emergent causes of acute neck pain. Correct diagnosis relies on characteristic radiographic findings on CT. Fortunately, patients may be discharged home with a short course of anti-inflammatories and corticosteroids with near-complete resolution of symptoms. Emergency physicians, therefore, can rule out life-threatening causes of neck pain, while also making a definitive diagnosis and initiating effective management for this pathology.

A review of medical malpractice cases involving trainees in the emergency department.

Background: This study characterizes medical malpractice lawsuits involving trainees providing care in the emergency department (ED), affording insight into the types of patients involved, clinical scenarios, and legal outcomes of these cases. Methods: Cases were identified using the legal database, Westlaw. Per chart review methods, relevant information was abstracted by 2 trained reviewers onto a standardized data abstraction form, with a senior author arbitrating disagreements. Results: We identified 60 cases reported between 1982 and 2017 in which a trainee was named in a lawsuit related to patient care provided in the ED. The most common alleged errors included diagnostic (n = 37, 61%), treatment (n = 13, 21%), and procedural errors (n = 19, 16%). In 21 cases (35%), it was alleged that no attending physician was directly involved in the care at any time. The attending was noted to have seen the patient in person at any point in only 11 total cases (18%). Of the 50 cases with known outcomes, 15 (30%) decided in favor of the patient, 21 (42%) were resolved in the physician's favor, and 14 (28%) were settled. Conclusion: This study underscores that trainees are vulnerable to malpractice cases and that lack of direct supervision is a prominent theme in these cases. This information suggests areas for further work and may help training programs, trainees, and supervising physicians design their practice patterns in ways that mitigate these risks in the future.

Relationship Between Pain Management Modality and Return Rates for Lower Back Pain in the Emergency Department.

BACKGROUND: Emerging evidence suggests that opioid use for patients with acute low back pain does not improve functional outcomes and contributes to long-term opioid use. Little is known about the impact of opioid administration in the emergency department (ED) for patients with low back pain. OBJECTIVES: This study compares 30-day return rates after administration of various pain management modalities for emergency department (ED) patients with low back pain. METHODS: We conducted a retrospective multicenter observational study of patients in the ED who were diagnosed with low back pain and discharged home in 21 EDs between November 2018 and April 2020. Patients were categorized based on the pain management they received in the ED and compared with the reference group of patients receiving only nonsteroidal anti-inflammatory drugs, acetaminophen, or a combination of the two. The proportions of ED return visits within 30 d for each medication category was calculated and associations between analgesia categories and proportions of return visits were assessed using logistic regression models to obtain odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Patients with low back pain who received any opioid, intravenous opioid, or intramuscular opioid had significantly increased proportions of a return visit within 30 d (32% [OR 1.78 {95% CI 1.21-2.64}]; 33% [OR 1.83 {95% CI 1.18-2.86}]; and 39% [OR 2.38 {95% CI 1.35-4.12}], respectively) when compared with patients who received nonsteroidal anti-inflammatory drugs (19%), acetaminophen (20%), or a combination of the two (8%). CONCLUSIONS: Patients receiving opioids were more likely to return to the ED within 30 d than those receiving received nonsteroidal anti-inflammatory drugs or acetaminophen. This suggests that the use of opioids for low back pain in the ED may not be an effective strategy, and there may be an opportunity to appropriately treat more of these patients with nonopioid medications.

Medicare Reimbursement to Physicians Decreased for Common Emergency Medicine Services From 2000 to 2020.

STUDY OBJECTIVE: The change in reimbursement rates for emergency physician services has yet to be quantified. We attempted to fill this knowledge gap by evaluating the monetary trends in Medicare reimbursement rates over the last 20 years for the most common emergency medicine services. METHODS: We obtained commonly used Current Procedural Terminology (CPT) codes in emergency medicine from the American College of Emergency Physicians website. We queried the Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services for each of the included CPT codes, and we extracted reimbursement data. We adjusted all monetary data for inflation to 2020 US dollars by using changes to the United States consumer price index. Both the average annual and the total percentage change in reimbursement were calculated on the basis of these adjusted trends for all included services. RESULTS: Reimbursement by Medicare for the services decreased by an average of 29.13% from 2000 to 2020 after adjusting for inflation. There was a stable decline in adjusted reimbursement rates throughout the study period, with an average decrease of 1.61% each year. The largest decrease was seen for laceration repairs up to 7.5 cm, with reimbursement rates for all 4 relevant CPT codes decreasing by more than 60%. CONCLUSION: When adjusted for inflation, Medicare reimbursement declined by an average of 29% over the last 20 years for the 20 most common emergency medicine services. Knowledge of these trends is essential to address current controversies in emergency medicine billing adequately and advocate for sustainable payment system reform.