Hartford Hospital, Inc.

Conventionally, susceptibility testing and pharmacokinetic/pharmacodynamic relationships are determined using standard inoculum (i.e., 10 5 –10 6 CFU). These may be poorly predictive of efficacy for high-inoculum infections, especially amongst β-lactamase-producing organisms. A. J. Kunz-Coyne, R. Gray, E. May, H. Curry, et al. (Antimicrob Agents Chemother 69:e01170-25, 2025, https://doi.org/10.1128/aac.01170-25 ) used a 96-h simulated endocardial vegetation model to describe pharmacodynamic efficacy, resistance emergence, and β-lactamase expression that resulted after clinically relevant exposures of antibiotics against three Enterobacter cloacae complex isolates, demonstrating that MIC values were often poorly predictive of efficacy in the model.

Ghost scanning refers to when a point-of-care ultrasound (POCUS) is performed, but no images are saved. This is a common, yet understudied, problem with POCUS examinations and has consequences for patient care, billing, and quality assurance. Previous studies were single-site and have shown a high rate of ghost scanning, but there is a lack of direct comparison across institutions. The study aim was to compare the prevalence of ghost scanning across multiple institutions for patients with trauma activations who received an Extended Focused Assessment with Sonography in Trauma (eFAST) examination.

This was a multi-center, retrospective cohort study that took place between July 1, 2021, and June 30, 2023. Study sites included four urban Level 1 trauma centers with emergency medicine residencies and emergency ultrasound fellowships. Inclusion criteria were emergency department patients >18 years old who arrived as the highest level of trauma activation at each site. Patients were excluded if there was incomplete or missing electronic medical record (EMR) data, if the patient was determined to not be a trauma by EMR review, or if the patient was downgraded from a trauma. Investigators manually reviewed EMR documentation for performance of an eFAST examination, and then searched their respective image repository for corresponding saved images. The primary study outcome was the prevalence of ghost scanning at each site. Descriptive statistics were reported, along with site comparisons using an ANOVA test with a post-hoc Tukey honestly significant difference (HSD). Secondary outcomes included a comparison of ghost scanning rates for each site broken down both by trauma type (blunt or penetrating) and eFAST examination result (positive or negative).

A total of 6078 patients were included in the analysis from the four study sites. Approximately 35 % (2182) of all trauma activations had an eFAST performed, ranging from a low of 24.5 % (444) to a high of 49.0 % (596). The overall ghost scanning rate was 49.8 % for the cohort, with 1086 images saved. The ghost scanning rate across institutions was highly variable, and ranged from 21.1 % to 93.2 % at the included sites. There was a significant difference between all sites when compared as independent pairs (p < 0.001). A statistically significant decrease in ghost scanning rates for positive eFAST examinations was seen at site 2 (p = 0.001), and site 3 had a statistically significant increase in ghost scanning rates for penetrating trauma (p = 0.02).

Ghost scanning is problematic and has implications for accreditation, liability, billing, quality assurance, and patient care. There was variable, but universally high rates, of ghost scanning for patients with a trauma activations at the included sites. These results show that ghost scanning continues to be a concern in the emergency department and further studies are needed to test interventions to decrease its rates.

Hospital-based violence intervention programs (HVIPs) effectively reduce recidivism and improve outcomes, but their impact on posthospitalization service utilization for patients with penetrating injuries is unclear.

The aim of this article is to evaluate the impact of an HVIP on posthospitalization service utilization among patients with penetrating injuries.

A retrospective cohort study was conducted at our urban academic Level I trauma center in the Northeastern United States to assess posthospitalization service utilization, including inpatient rehabilitation and home health services, among patients with gunshot or stab wounds during the first year of HVIP implementation (October 2022–September 2023). Comparisons between the HVIP and non-HVIP groups were made using Mann–Whitney U and Chi-square/Fisher’s exact tests. Multivariate logistic regression evaluated predictors of posthospitalization service utilization.

Of the 192 patients, 62 were HVIP, and 130 were non-HVIP. The HVIP patients were younger (31 vs. 35 years; p = .010) and more likely to be injured by gunfire (77.4% vs. 45.4%; p < .001), with a higher median Injury Severity Score (4 vs. 1; p = .029). Posthospitalization service utilization was significantly higher in HVIP patients (25.8% vs. 9.2%; p = .002). Predictors of posthospitalization service utilization included hospital admission (OR: 10.5, p = .033), Hispanic ethnicity (OR: 3.2, p = .035), and higher Injury Severity Score (OR: 1.2, p < .001). The HVIP involvement had a positive but nonsignificant association (OR: 2.5, p = .078).

Hospital-based violence intervention programs may increase posthospitalization service utilization and promote health equity for patients with penetrating injuries. Larger studies are needed to confirm these findings.