This Week in Emergency Medicine — Jun 11, 2026

Welcome to This Week in Emergency Medicine. This week we're covering 7 notable papers spanning critical care controversies, diagnostic dilemmas, and novel tools for the ED. Let's dive in.

We begin in critical care, where a highly anticipated trial provides a definitive, and concerning, answer on a popular therapy for severe burns. Published in JAMA, the VICTORY randomized clinical trial investigated whether high-dose intravenous vitamin C could reduce mortality and organ dysfunction in patients with severe burns covering 20% or more of their body surface area [1]. This international, multicenter trial randomized 238 patients to either vitamin C or placebo. The results were stark enough to stop the trial early for futility and potential harm. The primary composite outcome of 28-day mortality or persistent organ dysfunction occurred in about 41% of the vitamin C group compared to just under 30% in the placebo group. More alarmingly, 28-day mortality was significantly higher with vitamin C, at 15% versus 7.6% with placebo, which translates to nearly double the risk of death. Hospital mortality was also higher. The clear conclusion here is that high-dose intravenous vitamin C should not be used in severe burn injury; it does not help and is possibly harmful. Shifting to another critical care emergency, a study in *Resuscitation* looks at trends in managing cardiac arrest due to pulmonary embolism [2]. Using a nationwide inpatient database from Japan covering over a decade and more than 10,000 patients, researchers found a significant shift in treatment patterns. The use of thrombolytic therapy has fallen dramatically, from 16% of cases in 2012 down to about 7% in 2023. In its place, the use of extracorporeal membrane oxygenation, or ECMO, has risen from 16% to nearly 21%. Over this same period, there has been a modest but statistically significant improvement in outcomes. Survival to discharge increased from about 21% to 24%, and favorable neurological outcomes rose from 17% to 21%. The authors note these improvements were most evident in patients with hospital-acquired PE and in those who received ECMO, suggesting the shift towards mechanical support may be driving better outcomes in this devastating condition.

Next, we turn to common diagnostic challenges and sobering data on care disparities. For the ubiquitous ED presentation of chest pain, a study in *Internal and Emergency Medicine* prospectively validated a modified HEART score, or mHEART, to help rule out acute coronary syndrome [6]. In this prospective observational study, the mHEART score demonstrated a slightly better performance than the classic HEART score and was substantially better than the GRACE score for identifying low-risk patients. The classic and modified HEART scores both had an excellent negative predictive value of 99%. Critically, the authors found that when the mHEART score was combined with guideline-recommended high-sensitivity troponin testing, it could identify nearly half of the entire chest pain population as safe for discharge, with a major adverse cardiovascular event miss-rate of only 0.5%. This suggests the mHEART score could be a powerful tool to enhance efficiency and safety in our chest pain workups. From deciding who to work up to deciding who to admit, a quasi-experimental study in the *Annals of Internal Medicine* examined the impact of hospital admission on patients with dementia [4]. Using United States Medicare data for over 870,000 ED visits, researchers used an instrumental variable analysis to see what happens when these vulnerable patients are admitted. The findings are thought-provoking: there was no evidence that hospital admission was associated with a change in 30-day mortality. The data were compatible with anything from a 5.2 percentage point decrease to a 0.1 percentage point increase in mortality. However, admission was clearly associated with higher costs, adding over $2,500 in 30-day health care spending, even after excluding the index admission itself. This study challenges the assumption that admission is always beneficial for patients with dementia and suggests we need to carefully consider the goals of care and the potential for harm from care transitions. Finally in this section, a single-center retrospective study, also in *Internal and Emergency Medicine*, uncovered profound disparities in sepsis outcomes [7]. Analyzing data from a hospital in South Brooklyn, researchers found that non-English-speaking patients fared significantly worse than their English-speaking counterparts. They had higher sepsis-based mortality, higher rates of vasopressor use, a greater need for mechanical ventilation, and higher ICU admission rates. They also had a higher incidence of both sepsis and septic shock to begin with. The differences were stark and statistically significant across the board. While this is a single-center study needing broader validation, it serves as a critical reminder of the deep-seated linguistic and ethno-racial disparities that impact our sickest patients and highlights an urgent area for public health and system-level intervention.

Our final theme explores novel approaches, from a pragmatic bedside therapy to cutting-edge digital support. For the emergency management of severe hyponatremia, a study in *The Journal of Emergency Medicine* investigated a practical alternative to 3% hypertonic saline [9]. Guidelines recommend a rapid 4-6 mEq/L increase in serum sodium, often using custom-mixed 3% saline. This retrospective study looked at using a single, prefilled 50 mL syringe of 8.4% sodium bicarbonate, which is readily available and has a comparable sodium load to 100 mL of 3% saline. In their cohort of 28 patients, this single dose achieved the target increase of at least 4 mEq/L in 46% of patients, with a median sodium increase of 3 mEq/L. The effect was similar regardless of the patient's renal function, and no cases of osmotic demyelination were observed. While this is preliminary evidence from a small study, it suggests that a single amp of sodium bicarbonate could be a safe, simple, and error-reducing option for the initial correction of severe hyponatremia. On the high-tech end of the spectrum, another paper in *The Journal of Emergency Medicine* explored how to make large language models, or LLMs, safer for clinical decision support [8]. The study focused on acute ENT emergencies like sudden hearing loss, epistaxis, and Bell's palsy, where guideline-adherent care is crucial. Researchers compared standard LLMs to models enhanced with a technique called retrieval-augmented generation, or RAG, which feeds the model with authoritative clinical practice guidelines as it generates a response. The results were clear: five blinded otolaryngologists rated the RAG-enabled models as significantly better across multiple domains, including diagnostic accuracy, management quality, and guideline adherence. Importantly, the RAG technique reduced the risk of misleading information. This suggests that simply integrating trusted sources directly into the AI's workflow could be a key step in making these tools reliable enough to support evidence-based decision-making in the ED.

If you only have time for one paper this week, make it the VICTORY trial on high-dose vitamin C for severe burns, published in JAMA [1]. This is a definitive, practice-changing, multicenter randomized trial that clearly demonstrates harm, not benefit, from a therapy that has been gaining traction. It's a critical piece of evidence that should immediately stop this practice.

Here are the key takeaways from this week in Emergency Medicine. First, do not administer high-dose intravenous vitamin C to patients with severe burns; the best available evidence from the VICTORY trial shows it increases mortality [1]. Second, in cardiac arrest from pulmonary embolism, practice is shifting away from thrombolysis and toward ECMO, a trend associated with modest improvements in survival and neurologic outcomes [2]. Third, for low-risk chest pain, the modified HEART score, when combined with high-sensitivity troponins, is a validated tool that can help you safely discharge nearly half of these patients from the ED [6]. Fourth, hospitalizing patients with dementia from the ED may not reduce their short-term mortality but does increase subsequent healthcare spending, urging us to carefully weigh the risks and benefits of admission [4]. And finally, be vigilant for disparities in care; a stark new study shows non-English-speaking patients with sepsis suffer from significantly higher rates of mortality, shock, and ICU utilization [7].

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.

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