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Article History

Received: 12 November 2025

Accepted: 2 March 2026

First Online: 5 April 2026

Declarations

:

: This study received an exemption determination from the Appalachian State University Institutional Review Board (IRB #HS-24-342) for the use of secondary, de-identified emergency department data. The research involved only de-identified administrative health records and publicly available environmental datasets and was conducted in accordance with institutional and federal guidelines for non-human subjects research.

: Not applicable. This study used secondary, de-identified emergency department records provided under a data use agreement and did not involve direct human participation.

: Not applicable. This study did not involve identifiable individual data or direct participation by human subjects, so consent to publish was not required.

: The authors declare no competing interests.