A recent Emergency Medicine digest,
as sent to subscribers

Study Type: Retrospective single-centre cohort study (n=262; Level I trauma centre, 2019–2024).

Key Question: Do individual TEG parameters detect early trauma-induced coagulopathy and predict transfusion and mortality better than conventional coagulation tests in severely injured patients?

Key Findings:

• TEG showed moderate performance for detecting eTIC (INR >1.2; prevalence 31.5%): maximum amplitude AUC 0.73, R-time AUC 0.65. R-time improved for severe coagulopathy (INR >1.5; AUC 0.81).
• Hyperfibrinolysis (LY30 >7%) was uncommon (6.9%).
• INR outperformed TEG parameters for predicting ≥5 units RBC in 24 h (AUC 0.85) and in-hospital mortality (AUC 0.79; overall mortality 22.8%).

Clinical Relevance: Individual TEG parameters should not replace conventional coagulation tests for prognostication, which is relevant to UK major trauma centres weighing viscoelastic testing within haemorrhage protocols.

Limitations: Coagulopathy was defined by INR, which biases the comparison toward conventional testing, and the single-centre retrospective design limits generalisability; effects on guided-resuscitation outcomes were not assessed.

Study Type: Prospective observational study (two US children's hospitals, n=454 visits)

Key Question: Is the Australian Mental Health Triage Scale (AMHTS) a reliable and valid triage tool for children presenting to the ED with behavioural health symptoms?

Key Findings:

• Interrater reliability was only fair (ICC 0.48, 95% CI 0.37–0.58; 221 dual-scored visits).
• Higher-acuity AMHTS scores were associated with greater resource use: score 1 (IRR 1.82, 1.12–2.96) and score 2 (IRR 1.64, 1.15–2.40) versus score 5; using an expanded behavioural-health resource definition, scores 1–4 all exceeded score 5.
• AMHTS discriminated more widely than ESI, which placed 94.1% of visits in category 2.

Clinical Relevance: With rising paediatric mental health attendances and boarding in UK EDs, and Manchester Triage System categories poorly differentiating this group, a mental health-specific tool may help prioritisation, though it is not ready for adoption.

Limitations: Fair reliability and US-only settings limit generalisability, and resource use is a proxy rather than a direct measure of clinical acuity or outcomes.

Study Type: Prospective cohort study (single-centre ED, n = 58; allocation by study-specific list rather than randomisation)

Key Question: In adults with acute symptomatic hyponatraemia, does a 20-minute rapid bolus of 3% hypertonic saline differ from a 3-hour continuous infusion in sodium correction, safety and 30-day outcomes?

Key Findings:

• 24-hour sodium correction was comparable between groups; one overcorrection (SCI arm) and no osmotic demyelination.
• 30-day hyponatraemia-related readmission: 13.8% (RIB) vs 41.4% (SCI), p = 0.019; exploratory aOR for readmission with SCI 7.04 (95% CI 1.56–31.80).
• Exploratory: higher baseline GCS associated with lower 30-day mortality (aOR 0.39, 95% CI 0.17–0.88); baseline Na ≤115.5 mmol/L predicted need for a second dose (AUC 0.754).

Clinical Relevance: Supports bolus dosing as at least comparable to slower infusion, which may be relevant where UK guidance (e.g. ESE/ESICM/ERA-EDTA, local trust protocols) allows either approach.

Limitations: Small, non-randomised study with wide confidence intervals and exploratory adjusted analyses, so the readmission signal is hypothesis-generating only.

Study Type: Retrospective single-centre cohort (pilot implementation study), one year of data.

Key Question: Can a regional interfacility transfer pathway for isolated craniomaxillofacial (CMF) trauma reduce unnecessary specialist consultation and transfers?

Key Findings:

• Pathway activated 55 times; most injuries were nasal bone fractures (52.7%), most commonly from falls (49.1%).
• On-call specialist consultation fell to 18.2% of cases from 100% pre-implementation; 78.2% were discharged and 16.4% transferred.
• Dispositions were concordant with pathway recommendations in 90.9% of cases.

Clinical Relevance: Suggests a structured referral pathway could reduce low-value transfers and specialist burden, relevant to UK major trauma networks and referring EDs managing isolated facial injuries.

Limitations: Small, uncontrolled, single-centre US study with no patient-level safety outcomes (missed injuries, adverse events), and only 40.9% follow-up, so safety and generalisability to NHS settings remain unproven.

Study Type: Prospective population-based cohort study (statewide OHCA registry, Victoria, Australia).

Key Question: How common are fatigue, anxiety and depression 12 months after OHCA, what predicts them, and how do they relate to quality of life and functional recovery?

Key Findings:

• Of 728 survivors followed up (68.2% of eligible), 35.8% reported fatigue, 22.6% anxiety and 18.0% depression.
• Higher symptom burden was associated with lower HRQoL (EQ-5D, SF-12), worse GOSE and reduced return to work (all p<0.001).
• Versus population norms, fatigue was markedly higher (SMD 0.64; 95% CI 0.50–0.78) and depression slightly higher (SMD 0.12), while anxiety was lower (SMD −0.27). Younger age, pre-existing anxiety/depression, diabetes and initial non-shockable rhythm predicted higher burden; EMS-witnessed arrest predicted lower.

Clinical Relevance: Fatigue is a common, under-recognised sequela, supporting structured psychological and fatigue screening within NHS post-OHCA follow-up pathways.

Limitations: Loss to follow-up (~32%) and telephone-based self-report may introduce non-response and reporting bias.

Study Type: Retrospective cohort study using difference-in-differences and event-study analyses (national OHCA surveillance data, South Korea; n=129,207).

Key Question: Does regional implementation of prehospital ALS with real-time video-assisted physician direction improve outcomes after adult OHCA?

Key Findings:

• SALS regions had a greater increase in prehospital time (+4.12 min; 95% CI 2.91 to 5.33) and prehospital ROSC (+1.35 percentage points; 95% CI 0.56 to 2.15) than non-SALS regions.
• No significant differential change in survival to discharge (-0.35 pp; 95% CI -1.31 to 0.62) or favourable neurological outcome (-0.35 pp; 95% CI -1.08 to 0.37).
• Differential pre-intervention trends were seen for prehospital time but not other outcomes.

Clinical Relevance: Remote physician oversight of prehospital ALS may raise ROSC rates without improving survival, which is relevant to UK debates on prehospital resource models, though South Korean EMS structure limits direct transferability.

Limitations: Observational, region-level design is vulnerable to residual confounding, and the prehospital time finding is compromised by non-parallel pre-intervention trends.

Study Type: Multicentre, prospective, quasi-randomised controlled study (Türkiye).

Key Question: Are shorter pulse checks during CPR associated with better capnographic dynamics and higher ROSC rates than longer checks?

Key Findings:

• ROSC was higher with pulse checks ≤5 seconds than >5 to ≤10 seconds (36.3% vs 19.5%; p=0.005) in 252 cardiac arrest patients.
• Pulse check duration independently predicted ROSC (adjusted OR 2.39, 95% CI 1.35–4.24).
• Within the ≤5 second group, ROSC was associated with smaller ETCO2 loss rates, faster ETCO2 recovery and higher pre- and post-CPR ETCO2 (all p<0.001).

Clinical Relevance: Supports keeping pulse checks as brief as possible, consistent with Resuscitation Council UK and ERC advice to limit interruptions in compressions, and reinforces ETCO2 monitoring during resuscitation.

Limitations: Quasi-randomised allocation raises confounding and selection bias concerns, and the authors acknowledge the findings are hypothesis-generating only.

Study Type: Retrospective analysis of remotely monitored AED timestamp data (8,115 activation events; Nihon Kohden devices; 2018-2026).

Key Question: Which post-activation step contributes most to delay in AED shock delivery, and is there a pad-application time target that supports a first shock within 60 seconds of power-on?

Key Findings:

• Power-on to pad application took a median 42 s (IQR 30-56) and accounted for a median 81% of the power-on-to-first-analysis interval (87% when analysis occurred after 60 s). Pad application to first analysis took a median 9 s.
• In 900 initially shock-advised events with recorded shock, pad application to shock took a median 15 s.
• Exploratory ROC analysis suggested pad application within about 50 s of power-on as a target for shock within 60 s.

Clinical Relevance: Pad application is the main modifiable delay, which supports focusing on public-access defibrillation (PAD) training and pad-handling design, and on bystander/dispatcher coaching of pad placement, in UK community resuscitation.

Limitations: Single-manufacturer device data without clinical, patient, or outcome information, and the 50 s target is exploratory and unvalidated.