Latest Emergency Medicine research

Top 10 this week

Week of 1 November 2026

1. 1

   Performance of 0/1 h versus 0/3 h pathways in patients with suspected myocardial infarction: a systematic review and individual participant data meta-analysis of randomised controlled trials

   Lancet (London, England) · Q1 journal · SR/MA of RCTs · Evidence level 1 (High) · 29 October 2026

   Across five randomized trials covering 110,933 patient presentations, emergency department stays averaged 314 minutes with 0/1-hour testing and 308 minutes with 0/3-hour testing. Direct discharge was also similar, while 30-day death or heart attack rates were low with both approaches but the safety estimate was imprecise. Substantial differences between studies mean results may vary by health system.

2. 2

   Telemedicine Consultation for Pediatric Trauma in Community ED Visits and Parent Experience of Care: A Stepped-Wedge Cluster-Randomized Clinical Trial

   JAMA network open · Q1 journal · RCT · Evidence level 1 (High) · 1 October 2026

   In a randomized trial across 10 community emergency departments, telemedicine consultations with pediatric trauma specialists did not significantly change parents' overall care ratings or distress, or how often children were transferred. Parents rated discharge and transfer experiences more favorably with telemedicine, but that was a subscale finding; whether better transition communication translates into meaningful benefits remains unknown.

3. 3

   Public access defibrillation by activated community first responders - the randomized HeartRunner trial

   Resuscitation plus · Q1 journal · RCT · Evidence level 1 (High) · 21 July 2026

   Community first responders improve OHCA survival

4. 4

   Impact of a Decision-Support Interface on Mental Workload and Stress in Prehospital Stroke Triage: A Randomized Crossover Trial

   The western journal of emergency medicine · Q1 journal · RCT · Evidence level 1 (High) · 5 September 2026

   In a randomized crossover simulation with 35 emergency medical technicians, a decision-support interface lowered mental-demand scores from 62.5 to 35.5 and improved heart-rate variability measures linked to workload. About 83% rated the system acceptable, but the trials lasted just 12 minutes; whether it improves real-world triage decisions or patient outcomes remains unknown.

5. 5

   Prehospital Analgesia in Trauma: A Systematic Review of Current Evidence

   Emergency medicine Australasia : EMA · Q1 journal · SR/MA of RCTs · Evidence level 1 (High) · 1 December 2026

   A review of 17 studies involving 17,115 injured adults found that opioids, ketamine, methoxyflurane and paracetamol relieved pain to varying degrees. No drug-attributed serious adverse events were reported apart from in one opioid study, while minor effects such as nausea and drowsiness were common. The overall evidence is reassuring, but varied protocols and study limitations leave important questions about best practice.

6. 6

   Impact of Live Preferential Music on Pain in the Emergency Care Setting: A Randomized Controlled Trial

   The western journal of emergency medicine · Q1 journal · RCT · Evidence level 1 (High) · 9 September 2026

   In a randomized trial, pain scores fell by about 1.3 points with live preferred music and 1.2 points with usual care, with no significant difference between groups. Pain medication use and vital signs were also similar, although some patients described feeling less pain; a larger study is needed to determine whether music offers added relief.

7. 7

   Opioid-free analgesia for acute renal colic: a randomized, double-blind, head-to-head comparison of intravenous ibuprofen, dexketoprofen trometamol and paracetamol in the emergency department

   Internal and emergency medicine · Q1 journal · RCT · Evidence level 1 (High) · 30 October 2026

   In a randomized trial of 251 adults, adjusted pain scores at 30 minutes were 9.5 points lower on a 100-point scale with dexketoprofen than with paracetamol. About two-thirds to three-quarters in each group achieved at least 50% pain reduction, with no significant difference between treatments; the single-centre findings leave the practical importance of the score difference uncertain.

8. 8

   Closed reduction and percutaneous fixation versus open reduction and internal fixation for displaced medial malleolar fractures: a randomized controlled trial

   European journal of trauma and emergency surgery : official publication of the European Trauma Society · Q1 journal · RCT · Evidence level 1 (High) · 31 August 2026

   Closed vs open fixation for displaced medial malleolar fractures

9. 9

   Contingency Methods for Cleaning Single-Use Medical Equipment in Crisis, Disaster, or War

   Prehospital and disaster medicine · Q1 journal · RCT · Evidence level 1 (High) · 14 September 2026

   In an exploratory trial of 90 single-use items, ten-minute immersion with peracetic acid, 70% ethanol or dish detergent cut bacterial counts and removed all detectable Haemophilus influenzae and Staphylococcus aureus from 47% of contaminated endotracheal tubes and laryngeal masks, without harming device function. While not a substitute for sterilization, these low-tech methods may be the only feasible rescue option when supplies run out in disasters or conflict.

10. 10

    Effect of blood transfusion on respiratory failure in severe trauma patients: A post hoc analysis of a randomized multicenter trial in Japan

    Injury · Q1 journal · RCT · Evidence level 1 (High) · 19 October 2026

    In a post hoc analysis of 417 severely injured patients, 40 developed respiratory failure within seven days. Greater platelet transfusion volume in the first 24 hours was associated with respiratory failure after adjustment, while red blood cell and plasma transfusions were not. The analysis cannot show that platelets caused the complication, so the finding needs confirmation.

Paper of the day, last two weeks

• Bougie guided versus Endotracheal tube with Stylet guided intubation in critically injured patients with Difficult airway characteristics (BEST trial): randomised clinical trial

  Scandinavian journal of trauma, resuscitation and emergency medicine · Q1 journal · RCT · Evidence level 1 (High) · 10 August 2026

  In 188 critically injured trauma patients with difficult-airway features, first-pass intubation succeeded in 71% with a bougie and 67% with a stylet, with no statistically significant difference. Intubations used video laryngoscopy and a standardized protocol; esophageal intubation occurred only in the stylet group, but this exploratory finding needs confirmation in a larger study.

• Effect of Topical Tranexamic Acid in Acute Spontaneous Epistaxis: A Randomized Controlled Trial

  The Laryngoscope · Q1 journal · RCT · Evidence level 1 (High) · 3 November 2026

  In a randomized trial of 162 patients whose spontaneous nosebleeds continued after first aid, topical tranexamic acid was more effective than placebo at stopping bleeding in the emergency department. It did not significantly reduce rebleeding within 24 hours, so its value appears to be immediate control rather than preventing recurrence.

• Revalidation of the M-DIRECT scale in prehospital identification of acute stroke patients for endovascular treatment

  BMC emergency medicine · Q1 journal · Cohort · Evidence level 3 (Low) · 4 August 2026

  Prehospital stroke triage identifies patients for endovascular treatment

• Association Between Craniotomy and Outcomes in Patients With Acute Subdural Hematoma: Analysis of a Nationwide Trauma Registry in Japan

  Neurosurgery · Q1 journal · Cohort · Evidence level 3 (Low) · 30 October 2026

  In matched patients with large acute subdural hematomas, 77% who underwent craniotomy survived to discharge, compared with 63% who did not. The observational study found no improvement in favorable neurological outcomes at discharge, and the survival association was strongest in patients 65 or older and those with lower Glasgow Coma Scale scores; treatment decisions still need to account for individual patient factors.

• Association Between Craniotomy and Outcomes in Patients With Acute Subdural Hematoma: Analysis of a Nationwide Trauma Registry in Japan

  Neurosurgery · Q1 journal · Cohort · Evidence level 3 (Low) · 30 October 2026

  In matched patients with large acute subdural hematomas, 77% who underwent craniotomy survived to discharge, compared with 63% who did not. The observational study found no improvement in favorable neurological outcomes at discharge, and the survival association was strongest in patients 65 or older and those with lower Glasgow Coma Scale scores; treatment decisions still need to account for individual patient factors.

• Association Between Craniotomy and Outcomes in Patients With Acute Subdural Hematoma: Analysis of a Nationwide Trauma Registry in Japan

  Neurosurgery · Q1 journal · Cohort · Evidence level 3 (Low) · 30 October 2026

  In matched patients with large acute subdural hematomas, 77% who underwent craniotomy survived to discharge, compared with 63% who did not. The observational study found no improvement in favorable neurological outcomes at discharge, and the survival association was strongest in patients 65 or older and those with lower Glasgow Coma Scale scores; treatment decisions still need to account for individual patient factors.

• Timing of the Adrenaline Administration in Witnessed Pediatric Out-of-Hospital Cardiac Arrest: Retrospective, National Cohort Study in Japan, Using a 2014-2020 Dataset

  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · Q1 journal · Prospective cohort · Evidence level 2 (Moderate) · 30 October 2026

  In a nationwide Japanese cohort of 259 children with witnessed out-of-hospital cardiac arrest, adrenaline timing was not associated with one-month survival or favorable neurologic outcome. The retrospective analysis compared treatment at different intervals after emergency services arrived, but small numbers in each interval limit certainty; it does not establish the best time to give adrenaline.

• Clinical Scores and Machine Learning at Matched Variable Domains in Acute Appendicitis: Performance of Recommended Rule-Out Thresholds in a CT-Verified Cohort

  Journal of clinical medicine · Q1 journal · Retrospective cohort · Evidence level 3 (Low) · 20 October 2026

  In 761 emergency patients selected for CT, the three appendicitis scores had sensitivities of 68% to 85%, well below their published 95% to 99%; 27 to 57 confirmed cases fell into each score's low-probability group. Machine learning was not distinguishable from the best-performing score, and was not externally validated, underscoring the need to verify rule-out thresholds in the population where imaging would be deferred.

• Validation of hs-cTnI-Alinity in the early diagnosis of acute myocardial infarction

  Clinical chemistry and laboratory medicine · Q1 journal · Cohort · Evidence level 3 (Low) · 27 October 2026

  Validates troponin thresholds for rapid ED myocardial infarction pathways

• Diagnostic Accuracy of Computed Tomography Versus Diagnostic Laparoscopy for Detecting Diaphragmatic Injury in Left Thoracoabdominal Penetrating Trauma: A Systematic Review and Meta-Analysis

  World journal of surgery · Q1 journal · SR of cohorts · Evidence level 2 (Moderate) · 26 October 2026

  In a meta-analysis of four studies involving 222 patients, CT detected 70% of left-sided diaphragm injuries and correctly ruled out injury in 94% of patients without one. A negative CT therefore cannot reliably exclude injury; diagnostic laparoscopy remains the reference standard and allows immediate repair, though the evidence base is small.

• A non-inferiority randomized controlled trial comparing nebulized fentanyl and intravenous morphine for acute pain management in the emergency department

  BMC emergency medicine · Q1 journal · RCT · Evidence level 1 (High) · 24 July 2026

  In a randomized trial of 72 stable adults with severe pain, nebulized fentanyl reduced pain about as much as intravenous morphine over 15 to 60 minutes, meeting the study's non-inferiority threshold. The small trial offers a noninvasive alternative for selected patients, but its short follow-up and narrow eligibility leave safety and effectiveness in higher-risk patients uncertain.

• Q-AortaECG: A Quantum-Inspired Multi-Agent 12-Lead ECG System for Early Triage of Acute Aortic Syndrome

  IEEE journal of biomedical and health informatics · Q1 journal · Prospective cohort · Evidence level 2 (Moderate) · 23 October 2026

  In a 700-patient locked test, Q-AortaECG identified 95.5% of confirmed acute aortic syndromes, but specificity was 72.1%, so false alarms remain a concern. In a reader study, assistance raised clinician sensitivity from 69.6% to 87.0%; silent-run alerts could have shortened time to the correct diagnostic pathway, but CT angiography and expert imaging remain the diagnostic standard.

Evidence summaries in Emergency Medicine

• Serotonin Syndrome
• Anaphylaxis
• Status Epilepticus
• Cholinergic Crisis
• Serum Osmolal Gap