30-Second Takeaway
- Risk‑stratified ED disposition with rapid transitional care reduced 30‑day death/CV hospitalization similarly in both sexes.
- Ultrasound contrast agents (UCAs) have a very low rate of severe acute adverse reactions in adults and children.
Week ending May 16, 2026
MedBrevia Grand Rounds: Selected 2026 evidence for emergency physicians
LLMs show sociodemographic differences in pediatric emergency recommendations
An ensemble of 10 LLMs produced >3.7 million outputs across 500 validated and 500 real pediatric cases and showed systematic recommendation differences by socioeconomic status and race. Cases labeled as Black and unhoused received higher rates of recommendations for urgent interventions (+10.5 pp), additional investigations (+14.1 pp), and maltreatment suspicion (+26.6 pp) versus white or higher‑income cases. The models also varied recommendations by caregiver demographics, but the magnitude was smaller than for child factors. Authors recommend caution using LLM recommendations that include sociodemographic identifiers and adding explicit guideline‑based safeguards to reduce bias.
Risk‑stratified ED disposition and rapid transitional care benefit men and women equally
In a prespecified secondary analysis of the COACH stepped‑wedge trial (5452 patients; 2461 females, 2991 males), the intervention reduced the composite of death or cardiovascular hospitalization at 30 days similarly for females and males (HR 0.88 for both sexes). No sex interaction was seen for the 30‑day primary outcome (P = .98) or 20‑month co‑primary outcome (P = .38). There was a sex interaction for 20‑month heart‑failure readmissions (P = .01), with a larger reduction in males than females. Implication: apply ED risk stratification and rapid postdischarge care broadly across sexes, while noting longer‑term readmission differences need further study.
Ultrasound contrast agents have very low rates of severe adverse reactions
A meta‑analysis of 74 studies including >1,000,000 adults and >36,000 children found severe acute ADRs at 6 per 100,000 adults and 16 per 100,000 children. Non‑severe acute ADRs occurred in 11 per 10,000 adults and 8 per 10,000 children; delayed reactions were extremely rare (<1 per million). No significant safety differences were detected between UCA products, and emergency management was effective in almost all serious cases.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.