Emergency Medicine

Prehospital UFH bolus improved culprit artery patency in STEMI without more major bleeding

This single-center, open-label RCT randomized 593 STEMI patients within 6 hours to weight-based UFH at first medical contact vs UFH only before PCI. Prehospital UFH increased initial infarct-related artery TIMI 2–3 flow from 27% to 43% (RR 1.59; 95% CI 1.27–1.98; p < 0.001). BARC 3–5 bleeding during the index hospitalization was low and similar (2.4% vs 2.0%; RR 1.16; 95% CI 0.39–3.45). In mature STEMI networks, these data support adding an early UFH bolus at first medical contact when bleeding risk is acceptable. 1

ML-assisted dispatch modestly improved prioritization of low-priority calls during resource strain

This randomized trial enrolled adult low-priority ambulance calls during resource-constrained situations at two Swedish dispatch centers. Patients were prioritized using an ML-based deterioration risk score vs usual clinical practice, with the primary outcome being correct first-ambulance assignment based on later NEWS2. Correct prioritization occurred in 68.3% of ML-assisted encounters vs 62.5% of controls (OR 1.28; 95% CI 1.00–1.63; p = 0.047). The intervention’s effect was modest, limited to low-priority calls, and the trial was underpowered, so broader clinical gains remain uncertain. 2

Fast brain MRI outperformed head CT for pediatric neurologic emergencies without prolonging LOS

This planned subanalysis compared ED children with new neurologic complaints receiving fast brain MRI vs matched groups undergoing head CT first. Time from arrival to completed imaging was similar between fast MRI and CT (142 vs 139 minutes), as was hospital length of stay (47 vs 45 hours). Fast MRI had fewer missed lesions on follow-up imaging (1.8% vs 8.5%) and higher sensitivity and negative predictive value than CT. In nontrauma pediatric neurologic presentations, fast MRI pathways can reduce missed pathology without worsening ED throughput or hospitalization duration. 3

Targeted interventions moderately improved pediatric readiness scores in general EDs

This systematic review identified five nonrandomized studies assessing interventions to improve weighted Pediatric Readiness Scores in general EDs. Interventions included customized performance reports, online resources, simulations, expert consultations, and pediatric toolkits, often bundled together. Across studies, median readiness scores rose from about 54% to 80%, representing absolute gains around 13–17 percentage points, with moderate certainty evidence. Heterogeneity, pre–post designs, and possible selection and publication biases limit confidence, but multicomponent strategies appear promising levers for ED leaders. 4