30-Second Takeaway
- New multidisciplinary PE guideline standardizes ED risk categories and acute-to-post-acute care decisions.
- ESC 0/1-hour and High-STEACS troponin pathways both perform well but trade sensitivity for throughput.
- Low-value pediatric ED care is common, with higher use in White children and persistent inequities within hospitals.
Week ending February 21, 2026
ED care for PE, chest pain, arrest, and trauma: new data to refine risk, resources, and resuscitation
2026 AHA/ACC/ACEP PE guideline introduces unified clinical categories and full-pathway recommendations
This de novo guideline defines Acute Pulmonary Embolism Clinical Categories to refine severity assessment and prognostication in adults with acute PE. It offers evidence-based guidance from symptom onset through post-acute follow-up, covering ED, inpatient, and early outpatient management. Recommendations address diagnostic testing, including imaging and adjunctive cardiovascular studies, using a structured risk-based framework. Therapeutic guidance spans anticoagulation, advanced interventional options, and in-hospital supportive care aligned with clinical categories. Emergency physicians can use these categories to standardize ED disposition, escalation decisions, and early follow-up planning for PE patients.
ESC 0/1-hour vs High-STEACS troponin pathways: similar accuracy, different rule-out efficiency
Among 4,663 ED patients with chest discomfort, 14.2% had adjudicated type 1 NSTEMI. With hs-cTnI-Architect, the ESC 0/1-hour algorithm achieved 100% sensitivity but ruled out fewer patients than High-STEACS 0/2-hour (52% vs 72.5%). Sensitivity differences narrowed with hs-cTnI-Centaur/Atellica and disappeared with hs-cTnT-Elecsys, while ESC 0/1-hour maintained higher specificity across assays. An external cohort of 2,485 patients confirmed overall excellent, comparable performance for both strategies. Hospitals must choose between slightly higher sensitivity and specificity with ESC 0/1-hour versus greater throughput with High-STEACS when using hs-cTnI.
Low-value pediatric ED care is frequent and disproportionately affects White children
This cross-sectional PHIS study included 314,138 ED discharges for asthma, bronchiolitis, headache, and minor head injury from 2021 to 2023. Low-value care rates were high: asthma 18%, bronchiolitis 32%, headache 24%, and minor head injury 26%. White children had higher adjusted odds of receiving low-value care than Black and Hispanic children across multiple conditions. Pooled adjusted odds ratios for White vs Black children were 1.51 for asthma and 1.57 for headache. Lower hospital-level low-value care rates did not reduce within-hospital racial and ethnic differences, implying targeted equity efforts are necessary.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.