Emergency Medicine

Time-to-peak pain history outperforms “sudden onset” for ruling-in dangerous abdominal pathology

Among 629 ED patients with ≤7 days of abdominal pain, 3.2% had rupture, dissection, vascular occlusion, torsion, or perforation. Classifying onset by instantaneous time-to-peak yielded higher specificity (94.3%) than simply asking about sudden onset (86.7%). Sensitivity remained low and similar for both approaches (30.0% vs 40.0%), with no statistically significant difference. Time-to-peak questioning can strengthen rule-in for catastrophic abdominal disease but cannot safely exclude it and must be paired with imaging and serial exams. 1

Nationwide VOC data show widespread failure to deliver timely ED analgesia

Using Epic Cosmos, investigators analyzed 474,409 ED vaso-occlusive encounters across 225 sites from 2019–2024. Median time to first pain medication—the ASH timeliness metric—ranged between 30 and 250 minutes across sites. Eighty-six percent of sites had median times above 60 minutes, indicating pervasive undertreatment delay. Pediatric sites delivered analgesia faster than adult sites (58 vs 83 minutes), while encounter volume did not consistently affect performance. 2

Implementation facilitation increases ED readiness for buprenorphine initiation

Across 33 ED-INNOVATION sites, medical directors and principal investigators rated buprenorphine readiness on 10-point scales at three time points. Implementation Facilitation increased mean readiness from 6.29 at baseline to 8.23 early and 8.39 late (both p < 0.0001). Reported barriers decreased in 13 of 15 domains, while facilitators increased in 13 of 19 domains over the facilitation period. Changes in readiness correlated most strongly with follow-up treatment availability, prescribing-practice knowledge, insurance coverage, nursing support, and addiction-treatment knowledge. 3

Ferritin-guided precision immunotherapy improves organ dysfunction but not mortality in sepsis

The ImmunoSep trial randomized 276 sepsis patients with pneumonia or bacteremia and immune phenotyping to precision immunotherapy or placebo plus standard care. Patients with macrophage activation-like syndrome received IV anakinra, whereas those with immunoparalysis received subcutaneous interferon gamma. By day 9, 35.1% of treated patients achieved a ≥1.4-point mean SOFA decrease versus 17.9% with placebo (difference 17.2%, 95% CI 6.8–27.2). Despite improved SOFA responses, 28-day mortality was not significantly different between groups. 4