This Week in Emergency Medicine — Jun 25, 2026

Welcome to This Week in Emergency Medicine. This week we're covering 9 notable papers spanning diagnostic innovations, artificial intelligence in triage, and preventive care strategies. Let's dive in.

We begin with diagnostic and risk-stratification advancements in the acute care setting, starting with a compelling study published in the Emergency Medicine Journal that examines the use of transoesophageal echocardiography during cardiopulmonary resuscitation. In patients presenting with non-traumatic out-of-hospital cardiac arrest, identifying a reversible cause rapidly is a major clinical hurdle. While traditional transthoracic echocardiography is frequently used, it is often limited by poor image quality and can lead to harmful interruptions in chest compressions. To address this, researchers in China conducted a prospective, single-centre exploratory study of forty-five consecutive adult patients with non-traumatic out-of-hospital cardiac arrest of unclear etiology who were eligible for transoesophageal echocardiography. Ultimately, forty-one patients were included in the final per-protocol analysis where emergency physicians, certified in the technique, performed a simplified five-view transoesophageal echocardiography examination during active cardiopulmonary resuscitation. The investigators found that the procedure was highly feasible, yielding diagnostic-quality images in all forty-three patients who completed image acquisition, with a remarkably short median door-to-transoesophageal echocardiography time of just thirteen minutes. Most notably, the scans identified a reversible etiology in thirty-nine percent of the patients. Among these identified cases, acute aortic dissection was unexpectedly the most common cause, accounting for half of the diagnoses, followed by massive pulmonary embolism in twenty-five percent, hypertrophic cardiomyopathy in nearly nineteen percent, and hypovolaemia in just over six percent. Furthermore, the real-time findings guided clinical interventions in over fifty-six percent of the cases where a cause was identified. Although there was no statistically significant difference in the rates of return of spontaneous circulation or twenty-eight-day survival between the patients with identified versus unidentified etiologies—with return of spontaneous circulation occurring in nearly forty-two percent of patients overall and twenty-eight-day survival at twelve percent—this study highlights transoesophageal echocardiography as a powerful diagnostic tool that can be safely integrated into active resuscitation to detect critical, time-sensitive pathologies without halting chest compressions. [8]

Remaining in the Emergency Medicine Journal, another diagnostic challenge we face daily is identifying which patients presenting with acute kidney injury have an obstructive cause requiring urgent urological intervention. To help clinicians risk-stratify these patients and avoid unnecessary imaging, researchers in France developed and internally validated a clinical prediction model called the KIT-FISTO risk stratification decision tree. This retrospective cohort study evaluated adult patients presenting with any stage of acute kidney injury under the Kidney Disease Improving Global Outcomes criteria to the emergency departments of Toulouse University Hospital. The researchers analyzed a derivation cohort of seven hundred and twenty-seven patients and an internal validation cohort of three hundred and sixty-four patients, defining the primary outcome of obstructive acute kidney injury as hydronephrosis on imaging that required either a urological intervention or Foley catheter insertion. The prevalence of obstructive acute kidney injury was nine percent in the derivation cohort and seven percent in the validation cohort. The resulting decision tree is remarkably simple and elegant. Patients presenting with lumbar, flank, or hypogastric pain were classified as high risk, with an observed rate of obstructive acute kidney injury of fifty-five percent in the derivation cohort and fifty-four percent in the validation cohort. Conversely, patients without pain who had a history of urinary tract surgery, abdominal cancer, a solitary functional kidney, or prostatic hyperplasia were categorized as moderate risk, with an obstructive acute kidney injury rate of four percent in the derivation cohort and two percent in the validation cohort. Crucially, the remaining patients, who made up over seventy percent of the study population, were classified as low risk because they had no pain and none of those specific medical history risk factors. In this large low-risk group, the rate of obstructive acute kidney injury was zero percent in the derivation cohort and zero percent in the validation cohort, yielding an exceptional sensitivity of ninety-eight percent in the derivation cohort and ninety-six percent in the validation cohort. Once this tool is externally and prospectively validated, it could allow emergency clinicians to confidently defer urgent renal imaging in more than two-thirds of patients presenting with acute kidney injury, streamlining care and reducing resource utilization. [9]

Moving from diagnostic imaging to front-door triage, the integration of digital health and artificial intelligence continues to be a major focus of research. A study published in the Emergency Medicine Journal evaluated the concordance between a digital artificial intelligence self-triage programme and the Dutch National Triage Standard, which represents physical triage by a trained nurse. Conducted across two emergency department locations of the OLVG hospital in Amsterdam, the study enrolled two hundred and three adult patients who arrived without ambulance transport. These patients underwent standard physical triage and also completed the digital self-triage application. The results revealed that agreement between the two methods was incredibly low, with a Cohen's kappa of just point zero nine two, indicating none to slight concordance. When compared to the gold-standard physical triage, the artificial intelligence tool overtriaged patients in nearly thirteen percent of cases and undertriaged them in over five percent of cases. Interestingly, the artificial intelligence tool was actually more sensitive at identifying patients who ultimately experienced serious clinical sequelae, such as hospital admission, a follow-up consultation, or death, classifying a higher proportion of these high-risk patients into the top two urgency tiers compared to standard physical triage. Additionally, the digital tool predicted the final discharge diagnosis in twenty-seven percent of cases. The authors also noted that patients referred by a general practitioner had significantly more clinical sequelae compared to self-referred patients. While these findings suggest that artificial intelligence self-triage holds potential for identifying high-acuity patients, the substantial rate of mismatch and the low overall concordance highlight that these systems require significant refinement and robust clinical validation before they can be safely integrated into our triage workflows. [2]

Next, we turn to harm reduction and preventive medicine, starting with a scoping review published in the Canadian Journal of Emergency Medicine that looks at emergency department-based take-home naloxone programs. As the opioid crisis continues to devastate communities across North America, distributing naloxone kits directly from the emergency department has become a widely promoted strategy to reach individuals at high risk for overdose. This scoping review synthesized twenty-four studies to evaluate the current state of the literature on these programs, focusing on patient-centered health outcomes, as well as patient and provider perceptions. Among the included literature, seven studies reported direct health outcomes, nine reported patient perceptions, and eight reported provider perceptions, while none provided cost-effectiveness data. The review confirmed that take-home naloxone programs are highly acceptable, with strong, broad support from both patients and emergency department providers. However, the authors identified a critical knowledge gap: there is currently a lack of high-quality, direct evidence demonstrating whether these emergency department-based distribution programs actually improve long-term patient health outcomes or if they are cost-effective. Despite these limitations in the current literature, the overwhelming consensus among experts and stakeholders is that take-home naloxone remains an essential, low-barrier harm reduction tool that should be routinely offered to patients at risk of opioid overdose during their emergency department visit. [7]

Finally, a study in PLoS Medicine shifts our focus to primary prevention, addressing a question that frequently arises when we review the medications of older patients with type 2 diabetes. While statin therapy is a cornerstone of cardiovascular prevention, older adults, particularly those over seventy-five, have been historically underrepresented in randomized clinical trials, leaving a gap in the evidence for primary prevention in this demographic. To address this, investigators conducted a target trial emulation study using territory-wide electronic health records from Hong Kong, analyzing over thirty thousand matched patients aged seventy-five to eighty-four and nearly thirty-eight hundred matched patients aged eighty-five and older, all of whom had type 2 diabetes and elevated low-density lipoprotein cholesterol but no history of cardiovascular disease, cancers, muscle-related disorders, or liver dysfunction. The study emulated eighty-four nested monthly trials on a rolling basis, comparing those who initiated statins to those who did not. The results were striking: in the seventy-five to eighty-four age group, statin initiation was associated with a thirty-one percent reduction in cardiovascular events and a thirty-five percent reduction in all-cause mortality. These benefits were fully preserved in the oldest cohort of patients aged eighty-five and older, who experienced a thirty-five percent reduction in cardiovascular events and a thirty-nine percent reduction in all-cause mortality. Importantly, the study found no significant increase in the risk of muscle-related adverse events or liver dysfunction in either age group, and the findings were benchmarked and validated against a younger cohort aged sixty to seventy-four. For emergency clinicians, who often serve as the safety net for older patients and have opportunities to discuss preventive health or coordinate with primary care, these findings provide strong, reassuring evidence that primary prevention statin therapy is both highly effective and safe in older diabetic populations, even well into their eighties and nineties. [1]

If you only have time for one paper this week, make it the prospective evaluation of transoesophageal echocardiography during non-traumatic out-of-hospital cardiac arrest published in the Emergency Medicine Journal. This study provides crucial, real-world evidence that emergency physicians can rapidly and successfully perform transoesophageal echocardiography during active chest compressions, identifying a reversible etiology in nearly forty percent of cases and directly guiding life-saving interventions without interrupting cardiopulmonary resuscitation.

Here are the key takeaways from this week in Emergency Medicine. First, performing a simplified transoesophageal echocardiography protocol during active cardiopulmonary resuscitation is highly feasible, with a median setup time of thirteen minutes, and can identify a reversible etiology in almost forty percent of patients with non-traumatic out-of-hospital cardiac arrest. Second, the KIT-FISTO decision tree is a highly sensitive tool that can identify patients at extremely low risk for obstructive acute kidney injury, potentially allowing clinicians to safely defer urgent renal imaging in over seventy percent of cases once externally validated. Third, current artificial intelligence self-triage applications show very low concordance with standard physical triage, meaning they are not yet ready for standalone clinical use, though they show promise in identifying patients destined for serious clinical sequelae. Fourth, while emergency department-based take-home naloxone programs enjoy strong support from both patients and providers, there remains a significant research gap regarding their direct impact on long-term clinical outcomes and cost-effectiveness. Finally, initiating statin therapy for primary prevention in patients aged seventy-five and older with type 2 diabetes is associated with a thirty percent to nearly forty percent reduction in cardiovascular events and all-cause mortality, with no significant increase in muscle or liver adverse events.

That's your roundup for This Week in Emergency Medicine. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.