Emergency Medicine

PECARN CSI rule is more sensitive and CT-sparing than NEXUS and CCR in injured children

Among 22,430 children after blunt trauma, 1.9% had a cervical spine injury and 56.9% underwent any cervical imaging. The PECARN CSI rule showed higher sensitivity (93.3%) than NEXUS (85.7%) and the Canadian C-spine Rule (90.8%) for pediatric CSI. Negative predictive value was very high for all rules, but PECARN’s NPV reached 99.8%, the highest among the three. Strict application projected lower CT use with PECARN (6.9%) compared with NEXUS (10.8%) and CCR (13.2%). These data support PECARN as the preferred rule to minimize missed pediatric CSI while reducing CT exposure and imaging volume. 1

Network meta-analysis highlights top-performing prehospital LVO stroke scales but no clear universal best

This systematic review and network meta-analysis included 58 studies, 58,381 patients, and 33 LVO stroke scales. Diagnostic performance varied widely, with sensitivities from 0.30 to 0.99 and specificities from 0.34 to 0.94 across scales. LARIO, FPSS, FACE2AD, and ACT-FAST had among the highest overall AUCs, approaching or exceeding 0.87 in various settings. In prehospital settings, FPSS, FAST VAN, and FACE2AD showed strong performance, while LARIO and ACT-FAST performed best in-hospital. Bayesian ranking favored POMONA, NIHSS, sNIHSS EMS, G-FAST, and SAFE, underscoring heterogeneity and context dependence. The authors conclude that despite several strong options, a simple, highly accurate, widely generalizable prehospital LVO tool is still lacking. 2

Each minute of foreign-body airway obstruction reduces survival and neurologic recovery

This nationwide MOCHI registry analysis evaluated 229 patients with foreign body airway obstruction times between 0 and 25 minutes. Thirty-day survival was 60%, and 47% achieved favorable neurologic outcome (CPC 1-3). Each additional minute of obstruction decreased adjusted odds of survival (aOR 0.86; 95% CI, 0.81-0.90). Each minute also reduced odds of favorable neurologic outcome (aOR 0.85; 95% CI, 0.80-0.89). Spline models showed a continuous, steep decline in outcomes from onset, with no safe time threshold. These findings reinforce the need for immediate bystander and EMS interventions and rapid definitive airway management. 3

ED peer navigator program after opioid overdose did not reduce subsequent opioid-related events

This randomized trial enrolled 253 adults presenting to four New York City EDs after opioid-involved overdose. Participants received either a peer wellness advocate intervention (Relay) or site-directed care with usual services. Over 12 months, opioid-related adverse events were similar between groups, with a rate ratio of 1.02 (95% CI, 0.72-1.45). Nearly 10% of participants died within a year, most from overdose, underscoring extreme baseline risk. Patients reported high satisfaction with the peer intervention, but no measurable reduction in adverse events was observed. Results suggest peer navigators alone may be insufficient without more intensive or pharmacologic treatment strategies. 4