Emergency Medicine

Fragmented EMS data limits learning health systems; national minimum dataset recommended

Prehospital data flows are fragmented and largely unidirectional, limiting outcome feedback and quality improvement. The authors argue for a national EMS minimum dataset with mandatory reporting and bidirectional data exchange. Existing registries show outcome tracking is feasible using minimal standardized datasets. Implementing bidirectional EMS-hospital data links could enable transparency, system learning, and resilient crisis response. 1

RAPID-CHF: a nine-item prehospital score that estimates acute heart failure probability

Among 271,204 EMS-transported dyspnea patients, the RAPID-CHF score (0–13) discriminated HF with AUC 0.836 in validation. Risk strata had clinically distinct prevalences: low 1.7%, moderate 13.6%, high 46.4% for heart failure. Decision-curve analysis showed greater net benefit than current EMS diagnosis strategies across relevant thresholds. RAPID-CHF uses routinely collected prehospital variables and may help prioritize early HF therapies in EMS workflows. 2

Preadmission metformin use in diabetic sepsis associated with lower mortality in meta-analysis

Meta-analysis of 14 studies (12,687 patients) found preadmission metformin associated with lower overall mortality (OR 0.58, 95% CI 0.44–0.75). Significant mortality reductions were reported at 28, 90, and 365 days and for in-hospital mortality, but not consistently for ICU or 30–60 day endpoints. Metformin exposure correlated with lower serum creatinine but higher lactate levels in pooled analyses. These observational data support using metformin history as a prognostic factor, not as evidence to change acute sepsis therapy. 3