2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T65c,We describe the prevalence of seven life-threatening diagnoses in Emergency Department (ED) patients with chest pain in a national ED group. Using data from 141 EDs staffed by US Acute Care Solutions (USACS) from January 2021 to December 2024 in 17 U.S. states, we used descriptive statistics to tabulate prevalences of seven life-threatening conditions in ED patients with atraumatic chest pain: acute coronary syndrome (ACS), pulmonary embolism (PE), pneumothorax, thoracic aortic dissection (TAD), esophageal rupture, pericardial tamponade, and ruptured aortic aneurysm. We used logistic regression to estimate the association between ACS, PE, or any life-threatening diagnosis with ED visit and site characteristics. In 13,744,869 ED encounters, 951,152 (6.9%) had a complaint of atraumatic chest pain with 52,410 (5.5%) of these diagnosed with a life-threatening condition in the ED. ACS was most common (4.5%), followed by PE (0.78%), pneumothorax (0.13%), TAD (0.09%), esophageal rupture (0.007%), pericardial tamponade (0.005%), and ruptured aortic aneurysm (0.002%). The prevalence of life-threatening diagnoses was higher in patients who were older, male, covered by commercial insurance, who had higher-acuity triage emergency severity index (ESI) levels, arrived by ambulance, and were seen in western U.S. EDs. Approximately 1 in 18 ED patients with atraumatic chest pain presents with a life-threatening condition. ACS is the most common followed by PE, pneumothorax and TAD. Other diagnoses are very rare. These data may serve as a priori pre-test probabilities for ED clinicians in the evaluation of chest pain.31:T68e,Patients with severe pulmonary embolism (PE) may experience hemodynamic instability with intubation and mechanical ventilation. However, the characteristics and outcomes of intubated PE patients have not been previously described in the literature. We conducted a retrospective cohort study of patients requiring activation of our hospital's Pulmonary Embolism Response Team (PERT) from 2012 to 2021 who were intubated within 24 h of their acute PE diagnosis. Our primary outcome was peri-intubation hemodynamic instability and death occurring within 30 min. Our secondary outcome was peri-intubation hemodynamic instability and death within 3 h of intubation. We included 51 patients. Within 30 min of intubation, seven (14%) patients had a new or increased vasopressor requirement, four (8%) suffered cardiac arrest, and 1 (2%) required ECMO. Within 3 h, 26 (51%) patients had a new or increased vasopressor requirement, six (12%) suffered cardiac arrest, and five (10%) required ECMO. Patients with a central PE (n = 29, 57%) were more likely to experience peri-intubation hemodynamic instability (OR 3.4, 95% CI [0.95, 13], p = 0.048). Patients who had right ventricular strain on CT (OR 3.7, 95% CI [1.01, 15], p = 0.043) or echocardiogram (OR 8.0, 95% CI [1.9, 42], p = 0.0014) were also more likely to experience hemodynamic instability. Peri-intubation hemodynamic deterioration occurs in more than half of patients with acute PE, and severe events, like cardiac arrest, are common. Physicians should be cautious when intubating PE patients. Further research is needed to identify optimal strategies to treat PE patients who require intubation.32:Ta5f,ABSTRACT Background Patients with severe pulmonary embolism (PE) may experience hemodynamic instability with intubation and mechanical ventilation. However, the characteristics and outcomes of intubated PE patients have not been previously described in the literature. Methods We conducted a retrospective cohort study of patients requiring activation of our hospital's Pulmonary Embolism Response Team (PERT) from 2012 to 2021 who were intubated within 24 h of their acute PE diagnosis. Our primary outcome was peri‐intubation hemodynamic instability and death occurring within 30 min. Our secondary outcome was peri‐intubation hemodynamic instability and death within 3 h of intubation. Results We included 51 patients. Within 30 min of intubation, seven (14%) patients had a new or increased vasopressor requirement, four (8%) suffered cardiac arrest, and 1 (2%) required ECMO. Within 3 h, 26 (51%) patients had a new or increased vasopressor requirement, six (12%) suffered cardiac arrest, and five (10%) required ECMO. Patients with a central PE ( n = 29, 57%) were more likely to experience peri‐intubation hemodynamic instability (OR 3.4, 95% CI [0.95, 13], p = 0.048). Patients who had right ventricular strain on CT (OR 3.7, 95% CI [1.01, 15], p = 0.043) or echocardiogram (OR 8.0, 95% CI [1.9, 42], p = 0.0014) were also more likely to experience hemodynamic instability. Conclusion Peri‐intubation hemodynamic deterioration occurs in more than half of patients with acute PE, and severe events, like cardiac arrest, are common. Physicians should be cautious when intubating PE patients. Further research is needed to identify optimal strategies to treat PE patients who require intubation. 33:T4a8,High-risk pulmonary embolism (PE) manifests as obstructive shock or cardiac arrest and requires immediate treatment. Our aim was to explore survival and bleeding complications of prehospital fibrinolysis in the treatment of suspected high-risk PE. We collected patient data from the emergency medical services (EMS) registry of the Helsinki metropolitan area and the hospital database of Helsinki University Hospital between 2007 and 2019. The inclusion criteria were clinically suspected, high-risk PE treated with intravenous fibrinolysis by EMS. Diagnosis of PE was confirmed in all patients with imaging or by autopsy. Patients who did not receive prehospital fibrinolysis served as comparators. The study included sixty patients. Twenty-three patients, 44% female, with a mean age of 57 years received prehospital fibrinolysis. Seventeen of those patients (74%) had suffered cardiac arrest and six patients (26%) had obstructive shock as the leading manifestation. Prehospital mortality was 35% ( Out-of-hospital high-risk PE is associated with high mortality. In this case-series, fibrinolysis appears to be safe. The possible survival benefit needs to be confirmed in further trials.34:T920,Patients with intermediate-high risk pulmonary embolism (PE) have an elevated right ventricular (RV) to left ventricular (LV) diameter ratio and are at risk of early clinical decompensation and mortality. Reperfusion therapy aims to rapidly relieve acute RV pressure overload and to normalize hemodynamics. STORM-PE (A Prospective, Multicenter, Randomized Controlled Trial Evaluating Anticoagulation Alone Versus Anticoagulation Plus Mechanical Aspiration With the Indigo Aspiration System for the Treatment of Intermediate-High Risk Acute Pulmonary Embolism) is the first reported randomized controlled trial to test the efficacy and to evaluate the safety of mechanical thrombectomy, specifically computer-assisted vacuum thrombectomy (CAVT) with anticoagulation compared to anticoagulation alone. STORM-PE is an international randomized controlled trial with 1:1 randomization to CAVT with anticoagulation or anticoagulation alone. Eligible adults had acute-onset (symptoms ≤14 days), intermediate-high risk PE and were normotensive, with an RV/LV ratio ≥1.0 on computed tomographic pulmonary angiography and elevated cardiac biomarkers. The primary end-point analysis tested for a difference between groups for the change in RV/LV ratio at 48 hours, assessed by a blinded independent imaging core laboratory. Secondary end points included major adverse events within 7 days (a composite of clinical deterioration necessitating rescue therapy, PE-related mortality, symptomatic recurrent PE, and major bleeding), adjudicated by an external clinical events committee. Additional outcomes included change in vital signs and core laboratory-assessed pulmonary artery obstruction at 48 hours. A total of 100 patients enrolled across 22 sites were randomized to CAVT (n=47) or anticoagulation alone (n=53). Baseline characteristics were comparable between arms. At 48 hours, mean reduction in RV/LV ratio was greater for CAVT (0.52±0.37) than anticoagulation (0.24±0.40), a difference of 0.27 (95% CI, 0.12-0.43; CAVT was superior to anticoagulation alone in reducing RV/LV ratio within 48 hours in patients with intermediate-high risk PE, accompanied by earlier normalization of vital signs and major adverse event rates comparable to those for anticoagulation. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05684796.35:Tfac, BACKGROUND: Patients with intermediate-high risk pulmonary embolism (PE) have an elevated right ventricular (RV) to left ventricular (LV) diameter ratio and are at risk of early clinical decompensation and mortality. Reperfusion therapy aims to rapidly relieve acute RV pressure overload and to normalize hemodynamics. STORM-PE (A Prospective, Multicenter, Randomized Controlled Trial Evaluating Anticoagulation Alone Versus Anticoagulation Plus Mechanical Aspiration With the Indigo Aspiration System for the Treatment of Intermediate-High Risk Acute Pulmonary Embolism) is the first reported randomized controlled trial to test the efficacy and to evaluate the safety of mechanical thrombectomy, specifically computer-assisted vacuum thrombectomy (CAVT) with anticoagulation compared to anticoagulation alone. METHODS: STORM-PE is an international randomized controlled trial with 1:1 randomization to CAVT with anticoagulation or anticoagulation alone. Eligible adults had acute-onset (symptoms ≤14 days), intermediate-high risk PE and were normotensive, with an RV/LV ratio ≥1.0 on computed tomographic pulmonary angiography and elevated cardiac biomarkers. The primary end-point analysis tested for a difference between groups for the change in RV/LV ratio at 48 hours, assessed by a blinded independent imaging core laboratory. Secondary end points included major adverse events within 7 days (a composite of clinical deterioration necessitating rescue therapy, PE-related mortality, symptomatic recurrent PE, and major bleeding), adjudicated by an external clinical events committee. Additional outcomes included change in vital signs and core laboratory–assessed pulmonary artery obstruction at 48 hours. RESULTS: A total of 100 patients enrolled across 22 sites were randomized to CAVT (n=47) or anticoagulation alone (n=53). Baseline characteristics were comparable between arms. At 48 hours, mean reduction in RV/LV ratio was greater for CAVT (0.52±0.37) than anticoagulation (0.24±0.40), a difference of 0.27 (95% CI, 0.12–0.43; P <0.001). Refined modified and modified Miller scores exhibited greater changes for CAVT than anticoagulation alone at 48 hours ( P <0.001). Early normalization of vital signs within 48 hours was more frequent after CAVT. The major adverse event rate within 7 days was not different between groups (CAVT, 4.3% versus anticoagulation, 7.5%; P =0.681). Two PE-related deaths occurred in the CAVT arm. CONCLUSIONS: CAVT was superior to anticoagulation alone in reducing RV/LV ratio within 48 hours in patients with intermediate-high risk PE, accompanied by earlier normalization of vital signs and major adverse event rates comparable to those for anticoagulation. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05684796. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Pulmonary Embolism: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Pulmonary Embolism (condition). Clinician-written summaries and actionable practice insights. 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Strongest independent predictor was prior DVT (aOR 18.3; 95% CI 5.22–63.9), followed by oxygen requirement (aOR 4.86), obesity (aOR 3.21), and smoking (aOR 2.59). Most DVT events were acute and left lower extremity–predominant.","limitations":"- Retrospective single-center design limits generalizability beyond Brazilian tertiary settings.\n- DVT incidence may be underestimated as screening was not universal (venous Doppler performed selectively).\n- Confounding from evolving COVID-19 variants and prophylaxis protocols across the 2020–2024 period is not fully addressed.","practice_takeaway":"Prioritize targeted venous Doppler ultrasound screening in COVID-19 inpatients with prior DVT history, obesity, active smoking, or supplemental oxygen need — these patients face the highest DVT risk despite routine pharmacological prophylaxis. DVT occurrence signals a high-risk patient likely to need ICU-level care and at serious risk of PE and death."}},{"doi":"10.1038/s41541-026-01528-3","pmid":"42472854","title":"Multiorgan Outcomes Following BNT162b2 mRNA Vaccination vs SARS-CoV-2 Infection: A 30-Million-Person Real-World Cohort Analysis","journal_title":"npj Vaccines","journal_issn":"2059-0105","published_at":"2026-07-19T00:00:00.000Z","url":"https://doi.org/10.1038/s41541-026-01528-3","source_score":17,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-24T13:38:12.350Z","updated_at":"2026-07-24T13:38:12.350Z","tags":[{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"brand","value":"Comirnaty","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"category","value":"Immunology","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"condition","value":"Cerebrovascular Disease","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"condition","value":"COVID-19","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"condition","value":"Major Adverse Cardiovascular Events","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"condition","value":"Myocarditis","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"condition","value":"Pericarditis","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"condition","value":"Pulmonary Embolism","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"generic","value":"BNT162b2","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"modality","value":"mRNA Vaccine","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"sample_size","value":"n=30300000","value_numeric":30300000},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"warning","value":"Biological sex was used as the stratification variable; gender identity data were not available.","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"warning","value":"The >9-month window for vaccinated-only groups shows elevated mortality vs. controls (males RR 1.22, females RR 1.40), likely reflecting survivorship bias and healthy vaccinee effect reversal over time—this should not be interpreted as vaccine-caused late mortality.","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"warning","value":"The study is limited to BNT162b2 (Pfizer-BioNTech) and excludes Moderna, Janssen, AstraZeneca, and Novavax recipients, limiting generalizability across vaccine platforms.","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"warning","value":"Total cohort size of 30.3 million is reported in the abstract, but individual group sizes across supplemental tables sum to a smaller overlapping network; the effective denominators per comparison vary substantially.","value_numeric":null},{"paper_doi":"10.1038/s41541-026-01528-3","tag_type":"warning","value":"TriNetX suppresses event counts below 10 and reports them as '10' for de-identification, which may meaningfully inflate relative risks for rare outcomes (e.g., thrombosis with thrombocytopenia, ECMO use).","value_numeric":null}],"summaries":{"what_studied":"This retrospective cohort study used the TriNetX US network (Dec 2020–Dec 2024) to compare 50 cardiovascular, cerebrovascular, and mortality outcomes across four mutually exclusive groups: unvaccinated/uninfected controls (n≈27M), SARS-CoV-2 infected/unvaccinated, BNT162b2-vaccinated only, and hybrid immunity (infected + vaccinated). Outcomes were tracked over four time windows (0–3, 3–6, 6–9, and >9 months), stratified by biological sex.","key_result":"SARS-CoV-2 infection drove 3- to 5-fold acute cardiovascular risk increases vs. controls, including myocarditis (males RR 4.44, females RR 5.59) and all-cause mortality (males RR 4.53), with elevated risk persisting beyond 9 months. BNT162b2 vaccination reduced MACE by 65–76% in the acute phase vs. controls. Completing the two-dose primary series cut mortality by 77% and myocarditis by 62% vs. one dose. Hybrid immunity added a 36–38% MACE reduction vs. infection alone; however, males with hybrid immunity showed late pericarditis elevation beyond 9 months (RR 1.80).","limitations":"- Observational design using EHR claims data prevents causal inference and is subject to residual confounding (e.g., unmeasured comorbidities, healthcare-seeking behavior).\n- TriNetX privacy threshold suppresses counts below 10, potentially inflating relative risks for rare events.\n- Study is BNT162b2-specific and limited to a US population; results may not generalize to other vaccines or settings.","practice_takeaway":"For patients weighing COVID-19 vaccination risks and benefits: infection carries far greater and more sustained cardiovascular harm than BNT162b2 vaccination across all sex and age groups. Completing the full two-dose primary series provides substantially more protection than a single dose—clinicians should continue to prioritize vaccination completion."}},{"doi":"10.1016/s2213-2600(26)00086-x","pmid":"42398511","title":"PERC-Peds rule for bedside exclusion of pulmonary embolism without radiation in children in the USA (BEEPER): a multicentre, prospective, observational, diagnostic accuracy study","journal_title":"The Lancet Respiratory Medicine","journal_issn":"2213-2600","published_at":"2026-07-03T00:00:00.000Z","url":"https://doi.org/10.1016/s2213-2600(26)00086-x","source_score":8,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-09T13:35:57.252Z","updated_at":"2026-07-09T13:35:57.252Z","tags":[{"paper_doi":"10.1016/s2213-2600(26)00086-x","tag_type":"age_group","value":"adolescent","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00086-x","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00086-x","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00086-x","tag_type":"condition","value":"Deep Vein Thrombosis","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00086-x","tag_type":"condition","value":"Pulmonary Embolism","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00086-x","tag_type":"condition","value":"Venous Thromboembolism","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00086-x","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00086-x","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00086-x","tag_type":"modality","value":"Clinical Decision Rule","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00086-x","tag_type":"modality","value":"D-Dimer Testing","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00086-x","tag_type":"sample_size","value":"n=4011","value_numeric":4011},{"paper_doi":"10.1016/s2213-2600(26)00086-x","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00086-x","tag_type":"study_design","value":"Prospective Observational Diagnostic Accuracy Study","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00086-x","tag_type":"warning","value":"D-dimer cutoffs and assay types used across 21 sites were not standardized per the abstract; variability in D-dimer thresholds may affect reproducibility of the sequential strategy.","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00086-x","tag_type":"warning","value":"Specificity was low at 19.6%, meaning PERC-Peds alone would not reduce unnecessary testing substantially without the sequential D-dimer step.","value_numeric":null},{"paper_doi":"10.1016/s2213-2600(26)00086-x","tag_type":"warning","value":"The study enrolled children aged 4–17, so findings may not apply to younger children or infants. The lower age bound (4 years) is narrow and clinicians should exercise caution below this threshold.","value_numeric":null}],"summaries":{"what_studied":"This prospective diagnostic accuracy study tested whether the PERC-Peds rule could safely rule out pulmonary embolism (PE) or proximal DVT in children aged 4–17 years presenting to 21 U.S. pediatric EDs with suspected PE, with 45-day follow-up (enrolled July 2020–September 2024).","key_result":"Among 3,988 adjudicated participants (prevalence 6.3%), PERC-Peds achieved sensitivity 99.6% (95% CI 97.8–100.0%) and a false-negative rate of 0.1% (95% CI 0.0–0.8%), meeting the pre-specified safety threshold of <1.5%. Sequential PERC-Peds + D-dimer ruled out PE/proximal DVT in 54.3% of patients with a false-negative rate of 0.9% (95% CI 0.6–1.4%).","limitations":"- Low specificity (19.6%) means PERC-Peds alone does not confirm PE risk; most patients still required further workup.\n- D-dimer ordering was at clinician discretion, not protocolized, introducing potential selection bias in the sequential strategy.\n- Loss to follow-up or incomplete adjudication in 28 of 4,039 enrolled participants may slightly affect outcome ascertainment.","practice_takeaway":"A negative PERC-Peds rule can safely exclude PE and proximal DVT in pediatric ED patients without radiation exposure; combining it with D-dimer testing can avoid further workup in over half of children with suspected PE. Clinicians should consider implementing PERC-Peds as a first-line bedside tool to reduce low-value imaging in this population."}},{"doi":"10.1111/1742-6723.70305","pmid":"42366324","title":"Implementation of Electronic Clinical Decision Support for Radiology Referrals: The Role of Governance, Clinician Engagement and Education","journal_title":"Emergency Medicine Australasia","journal_issn":"1742-6731","published_at":"2026-06-28T00:00:00.000Z","url":"https://doi.org/10.1111/1742-6723.70305","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-02T13:33:26.229Z","updated_at":"2026-07-02T13:33:26.229Z","tags":[{"paper_doi":"10.1111/1742-6723.70305","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70305","tag_type":"brand","value":"Cerner Millennium","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70305","tag_type":"brand","value":"MedCurrent OrderWise","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70305","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70305","tag_type":"condition","value":"Imaging Overutilisation","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70305","tag_type":"condition","value":"Pulmonary Embolism","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70305","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70305","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70305","tag_type":"modality","value":"Clinical Decision Support System","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70305","tag_type":"modality","value":"Computed Tomography","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70305","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70305","tag_type":"study_design","value":"Descriptive Implementation Study","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70305","tag_type":"warning","value":"No inferential statistics were performed; observed utilisation changes cannot be causally attributed to eCDS or the engagement programme alone.","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70305","tag_type":"warning","value":"Sample size (number of patients or ED presentations) is not reported as a discrete figure — only utilisation rates per 100 ED presentations are provided, so a sample_size tag was omitted.","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70305","tag_type":"warning","value":"The impact_flag 'practice_changing' reflects the finding that pre-go-live engagement alone drove a measurable utilisation shift, which has direct workflow implications — but evidence level is observational.","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70305","tag_type":"warning","value":"The study covers multiple time periods (2017–2025); the 'engagement phase' and 'deployment phase' findings reflect institutional trends, not controlled comparisons.","value_numeric":null}],"summaries":{"what_studied":"This descriptive implementation study examined an organisational strategy for deploying an electronic Clinical Decision Support (eCDS) system (MedCurrent OrderWise integrated into Cerner Millennium EMR) for imaging referrals at a quaternary ED in Melbourne, Australia, evaluating CT utilisation trends across pre-engagement, engagement, and deployment phases from 2017 to mid-2025.","key_result":"CT utilisation rose from 32 to 44 per 100 ED presentations pre-eCDS. During the pre-go-live clinician engagement and education phase, CT ordering fell by 9.1% (44 → 40 per 100 ED presentations). After eCDS deployment, utilisation stabilised without further decline. For CTPA specifically, eCDS recommended alternative investigations in 28.8% of cases and CTPA positivity improved from 11.6% to 12.9%.","limitations":"- Single-centre, descriptive design with no inferential statistics — causal attribution to eCDS is not possible.\n- CT per ED presentation is an indirect surrogate; imaging appropriateness and decision quality were not formally assessed.\n- Concurrent education initiatives and organisational changes may independently explain observed utilisation shifts.","practice_takeaway":"Clinician engagement and education before eCDS go-live may drive early reductions in CT ordering — consider launching these activities well ahead of system deployment. Passive eCDS rollout alone is unlikely to achieve lasting change; governance structures and sustained education are key."}},{"doi":"10.1161/circinterventions.126.016573","pmid":"42312382","title":"Is There a Golden Hour for Thrombectomy in Intermediate-Risk Pulmonary Embolism? Insights From SYMPHONY-PE","journal_title":"Circulation: Cardiovascular Interventions","journal_issn":"1941-7640","published_at":"2026-06-18T00:00:00.000Z","url":"https://doi.org/10.1161/circinterventions.126.016573","source_score":26,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-22T13:24:15.137Z","updated_at":"2026-06-22T13:24:15.137Z","tags":[{"paper_doi":"10.1161/circinterventions.126.016573","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016573","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016573","tag_type":"condition","value":"Pulmonary Embolism","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016573","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016573","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016573","tag_type":"modality","value":"Catheter-Based Therapy","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016573","tag_type":"modality","value":"Mechanical Thrombectomy","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016573","tag_type":"sample_size","value":"n=109","value_numeric":109},{"paper_doi":"10.1161/circinterventions.126.016573","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016573","tag_type":"study_design","value":"Prospective Cohort Study (Registry Sub-analysis)","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016573","tag_type":"warning","value":"No specific drug brand or generic agent is associated with mechanical thrombectomy in this study; modality tags reflect the procedural intervention only.","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016573","tag_type":"warning","value":"The primary efficacy endpoint (RV/LV ratio reduction) only approached statistical significance (P=0.071); the mean pulmonary artery pressure result was significant but should be interpreted cautiously given the observational design.","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016573","tag_type":"warning","value":"This is a non-randomized sub-analysis of the SYMPHONY-PE registry; the early vs. late thrombectomy groups were not randomly assigned, so confounding by clinical urgency or operator judgment is possible.","value_numeric":null}],"summaries":{"what_studied":"Among 109 intermediate-risk PE patients enrolled in SYMPHONY-PE (NCT06062329), early mechanical thrombectomy (<12 hours from CT pulmonary angiography) was compared with late thrombectomy (≥12 hours) on acute pulmonary hemodynamics and RV mechanics, with safety assessed at 48 hours.","key_result":"Early thrombectomy (44% of patients, n=48) produced a greater reduction in mean pulmonary artery pressure vs. late (8.6±5.2 vs. 5.8±5.0 mmHg; P=0.006) and a larger but non-significant reduction in RV/LV ratio (0.52±0.50 vs. 0.37±0.34; P=0.071); major adverse event rates were similar between groups (P=0.431) with zero mortalities.","limitations":"Non-randomized comparison within an observational registry, limiting causal inference; timing cutoff of 12 hours was pre-specified but may not capture the full continuum of benefit; results may not generalize beyond intermediate-risk PE.","practice_takeaway":"Early mechanical thrombectomy (<12 hours) appears to yield greater hemodynamic benefit than delayed treatment in intermediate-risk PE, especially in higher-risk patients by Composite PE Shock score — but randomized trials are still needed before changing practice."}},{"doi":"10.1016/j.annemergmed.2026.05.003","pmid":"42313044","title":"Accuracy of Point-of-Care Ultrasound Versus Consultative Echocardiography to Identify Right Ventricular Dysfunction in Emergency Department Patients With Pulmonary Embolism","journal_title":"Annals of Emergency Medicine","journal_issn":"0196-0644","published_at":"2026-06-18T00:00:00.000Z","url":"https://doi.org/10.1016/j.annemergmed.2026.05.003","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-27T13:27:44.525Z","updated_at":"2026-06-27T13:27:44.525Z","tags":[{"paper_doi":"10.1016/j.annemergmed.2026.05.003","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.05.003","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.05.003","tag_type":"condition","value":"Pulmonary Embolism","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.05.003","tag_type":"condition","value":"Right Ventricular Dysfunction","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.05.003","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.05.003","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.05.003","tag_type":"modality","value":"Echocardiography","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.05.003","tag_type":"modality","value":"Point-of-Care Ultrasound","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.05.003","tag_type":"sample_size","value":"n=194","value_numeric":194},{"paper_doi":"10.1016/j.annemergmed.2026.05.003","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.05.003","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.05.003","tag_type":"warning","value":"Consultative echocardiography was used as the reference standard rather than a gold-standard outcome (e.g., mortality or hemodynamic decompensation), which limits conclusions about clinical impact.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.05.003","tag_type":"warning","value":"Inter-rater reliability declining with residency training level is counterintuitive and may reflect small subgroup sizes or confounding by case complexity — interpret with caution.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.05.003","tag_type":"warning","value":"Time interval between POCUS and consultative echo is not reported; hemodynamic changes between studies could affect agreement.","value_numeric":null}],"summaries":{"what_studied":"This retrospective cohort study evaluated the accuracy of emergency physician-interpreted POCUS versus cardiologist-interpreted consultative echocardiography for detecting right ventricular (RV) dysfunction in 194 ED patients with confirmed pulmonary embolism (PE), across 97 physician operators.","key_result":"POCUS showed 76.8% sensitivity and 85.9% specificity for RV dysfunction, with 81.4% overall agreement (kappa=0.63, 95% CI 0.51–0.75). Accuracy improved when consultative echo showed moderate-to-severe RV dysfunction; inter-rater reliability declined as residency training level increased.","limitations":"- Retrospective design limits causal inference and may introduce selection bias.\n- Not all PE patients received both POCUS and consultative echo, potentially skewing the sample toward higher-acuity cases.\n- Inter-rater reliability declining with training level suggests operator variability that may not generalize to all ED settings.","practice_takeaway":"POCUS is a reasonable first-line tool for RV dysfunction screening in ED patients with PE, but its moderate sensitivity (76.8%) means a negative result should not rule out RV dysfunction in high-risk patients. Consultative echo should be pursued when clinical concern persists, especially for moderate-to-severe dysfunction where POCUS performs best."}},{"doi":"10.1111/1742-6723.70297","pmid":"42283136","title":"Suspected Pulmonary Embolism Exclusion With D‐Dimers in Emergency Departments: Pregnancy (\n SPEED\n ‐\n ED\n Pregnancy). A Retrospective Evaluation of the Pregnancy‐Adapted\n YEARS\n Guideline","journal_title":"Emergency Medicine Australasia","journal_issn":"1742-6731","published_at":"2026-06-12T00:00:00.000Z","url":"https://doi.org/10.1111/1742-6723.70297","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-14T13:34:52.131Z","updated_at":"2026-06-14T13:34:52.131Z","tags":[{"paper_doi":"10.1111/1742-6723.70297","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70297","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70297","tag_type":"condition","value":"Pulmonary Embolism","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70297","tag_type":"condition","value":"Venous Thromboembolism","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70297","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70297","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70297","tag_type":"modality","value":"Clinical Decision Rule","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70297","tag_type":"modality","value":"D-Dimer Testing","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70297","tag_type":"sample_size","value":"n=532","value_numeric":532},{"paper_doi":"10.1111/1742-6723.70297","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70297","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70297","tag_type":"warning","value":"Follow-up outcome data were missing for 11% of the D-dimer-only post-guideline cohort, so the true missed PE rate cannot be confirmed with certainty.","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70297","tag_type":"warning","value":"The pre- and post-guideline observation periods differ substantially in length (2 vs. 5 years), which may affect comparisons of PE prevalence and practice patterns.","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70297","tag_type":"warning","value":"This is a single Australian tertiary centre study; applicability to lower-volume or different-resource settings is uncertain.","value_numeric":null}],"summaries":{"what_studied":"Single-centre retrospective cohort study evaluating the safety and effectiveness of the pregnancy-adapted YEARS guideline for PE exclusion in pregnant women presenting to a major Australian ED (Townsville University Hospital), comparing 2 years pre-guideline (July 2018–June 2020) to 5 years post-guideline (July 2020–June 2025).","key_result":"Post-guideline, 168/456 women (37%) were evaluated with D-dimers alone (avoiding imaging), with zero VTE events at 90 days among the 150 (89%) with available follow-up data; PE was diagnosed in 4/456 (0.9%) post-guideline vs. 1/76 (1.3%) pre-guideline.","limitations":"Single-centre retrospective design limits generalisability; outcome data were missing for 18/168 (11%) of D-dimer-only patients, leaving residual uncertainty about missed PE; pre-guideline period was only 2 years vs. 5 years post-guideline, making direct comparisons unequal.","practice_takeaway":"The pregnancy-adapted YEARS guideline safely excluded PE in pregnant ED patients using D-dimers alone in over a third of cases, with no known missed PE over 5 years. Clinicians can use this guideline with confidence to reduce unnecessary imaging in this population."}},{"doi":"10.1161/jaha.125.047893","pmid":"42250252","title":"Glucagon‐Like Peptide‐1 Receptor Agonists and Cardiovascular Events in Adults With Obesity and Autoimmune Disease: A Target Trial Emulation","journal_title":"Journal of the American Heart Association","journal_issn":"2047-9980","published_at":"2026-06-06T00:00:00.000Z","url":"https://doi.org/10.1161/jaha.125.047893","source_score":117,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-10T14:24:27.894Z","updated_at":"2026-06-10T14:24:27.894Z","tags":[{"paper_doi":"10.1161/jaha.125.047893","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1161/jaha.125.047893","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1161/jaha.125.047893","tag_type":"condition","value":"Autoimmune Disease","value_numeric":null},{"paper_doi":"10.1161/jaha.125.047893","tag_type":"condition","value":"Obesity","value_numeric":null},{"paper_doi":"10.1161/jaha.125.047893","tag_type":"condition","value":"Pulmonary Embolism","value_numeric":null},{"paper_doi":"10.1161/jaha.125.047893","tag_type":"condition","value":"Stroke","value_numeric":null},{"paper_doi":"10.1161/jaha.125.047893","tag_type":"condition","value":"Venous Thromboembolism","value_numeric":null},{"paper_doi":"10.1161/jaha.125.047893","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/jaha.125.047893","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1161/jaha.125.047893","tag_type":"modality","value":"GLP-1 Receptor Agonist","value_numeric":null},{"paper_doi":"10.1161/jaha.125.047893","tag_type":"sample_size","value":"n=26408","value_numeric":26408},{"paper_doi":"10.1161/jaha.125.047893","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/jaha.125.047893","tag_type":"study_design","value":"Target Trial Emulation (Retrospective Cohort Study)","value_numeric":null},{"paper_doi":"10.1161/jaha.125.047893","tag_type":"warning","value":"No significant reduction in MI or coronary revascularization was reported in the abstract; these null results are not highlighted in the conclusion but are clinically relevant.","value_numeric":null},{"paper_doi":"10.1161/jaha.125.047893","tag_type":"warning","value":"Specific autoimmune disease subtypes (e.g., rheumatoid arthritis, lupus, psoriasis) are not broken out in the abstract or results, limiting disease-specific applicability.","value_numeric":null},{"paper_doi":"10.1161/jaha.125.047893","tag_type":"warning","value":"The 'impact_flag' of practice_changing is applied cautiously — results are from an observational emulation, not an RCT, so some clinicians may prefer 'confirms_prior' pending randomized evidence.","value_numeric":null}],"summaries":{"what_studied":"This target trial emulation evaluated GLP-1RA use vs. nonuse in adults with obesity and comorbid autoimmune disease (AID), using 2014–2024 EHR data from the OneFlorida+ network, with outcomes including MACE, thromboembolic events, ED visits, and all-cause mortality.","key_result":"In 13,204 matched pairs (mean age 54.7 years; 73.4% women; mean BMI 37 kg/m²), GLP-1RA use was linked to lower hazard of stroke/TIA (HR 0.87), pulmonary embolism (HR 0.69), venous thromboembolism (HR 0.83), ED visits (HR 0.79), and all-cause mortality (HR 0.56) — all statistically significant. No significant reduction was seen for MI or coronary revascularization.","limitations":"- Retrospective observational design limits causal inference despite target trial emulation methodology.\n- EHR-based data may miss out-of-network events or have incomplete medication adherence records.\n- Autoimmune disease subtypes were not individually analyzed, so results may not apply equally across all AIDs.","practice_takeaway":"For patients with obesity and autoimmune disease, GLP-1RA therapy may reduce thromboembolic risk, ED utilization, and mortality — consider it an option when antiobesity pharmacotherapy is indicated. These findings support prospective trials in this underrepresented, high-risk population."}},{"doi":"10.1016/j.ajem.2026.05.006","pmid":"42114386","title":"The prevalence of life-threatening diagnoses in emergency department patients with chest pain in a national group","journal_title":"The American Journal of Emergency Medicine","journal_issn":"0735-6757","published_at":"2026-05-12T00:00:00.000Z","url":"https://doi.org/10.1016/j.ajem.2026.05.006","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-08","doi":"10.1016/j.ajem.2026.05.006","days":"7","issn":"0735-6757","rank":"5","field":"Clinical Medicine","score":"2","category":"Emergency Medicine","categories":["Emergency Medicine"],"_categories":["Emergency Medicine"]},"pubmed":{"doi":"10.1016/j.ajem.2026.05.006","title":"The prevalence of life-threatening diagnoses in emergency department patients with chest pain in a national group.","journal":"The American journal of emergency medicine","methods":"","results":"In 13,744,869 ED encounters, 951,152 (6.9%) had a complaint of atraumatic chest pain with 52,410 (5.5%) of these diagnosed with a life-threatening condition in the ED. ACS was most common (4.5%), followed by PE (0.78%), pneumothorax (0.13%), TAD (0.09%), esophageal rupture (0.007%), pericardial tamponade (0.005%), and ruptured aortic aneurysm (0.002%). The prevalence of life-threatening diagnoses was higher in patients who were older, male, covered by commercial insurance, who had higher-acuity triage emergency severity index (ESI) levels, arrived by ambulance, and were seen in western U.S. EDs.","abstract":"$30","keywords":["ACS","Chest pain","Dissection","Emergency","Life-threatening","Pulmonary embolism"],"pubmed_id":"42114386","conclusions":"Approximately 1 in 18 ED patients with atraumatic chest pain presents with a life-threatening condition. ACS is the most common followed by PE, pneumothorax and TAD. Other diagnoses are very rare. These data may serve as a priori pre-test probabilities for ED clinicians in the evaluation of chest pain.","publication_date":"2026-05-12T00:00:00"},"crossref":{"DOI":"10.1016/j.ajem.2026.05.006","URL":"https://doi.org/10.1016/j.ajem.2026.05.006","ISSN":["0735-6757"],"link":[{"URL":"https://api.elsevier.com/content/article/PII:S0735675726002123?httpAccept=text/xml","content-type":"text/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://api.elsevier.com/content/article/PII:S0735675726002123?httpAccept=text/plain","content-type":"text/plain","content-version":"vor","intended-application":"text-mining"}],"page":"96-101","type":"journal-article","issue":null,"score":1,"title":["The prevalence of life-threatening diagnoses in emergency department patients with chest pain in a national group"],"author":[{"given":"Daniel R.","family":"Rice","sequence":"first","affiliation":[]},{"given":"Michael J.","family":"Pallaci","sequence":"additional","affiliation":[]},{"given":"Michael B.","family":"Weinstock","sequence":"additional","affiliation":[]},{"given":"Samuel S.","family":"Cray","sequence":"additional","affiliation":[]},{"given":"Krista M.","family":"Foster","sequence":"additional","affiliation":[]},{"given":"Jonathan J.","family":"Oskvarek","sequence":"additional","affiliation":[]},{"given":"John J.","family":"Bedolla","sequence":"additional","affiliation":[]},{"given":"Amer Z.","family":"Aldeen","sequence":"additional","affiliation":[]},{"given":"Jesse M.","family":"Pines","sequence":"additional","affiliation":[]}],"issued":{"date-parts":[[2026,8]]},"member":"78","prefix":"10.1016","source":"Crossref","volume":"106","created":{"date-time":"2026-05-05T07:07:49Z","timestamp":1777964869000,"date-parts":[[2026,5,5]]},"indexed":{"date-time":"2026-05-11T23:21:28Z","timestamp":1778541688753,"date-parts":[[2026,5,11]]},"license":[{"URL":"https://www.elsevier.com/tdm/userlicense/1.0/","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"https://www.elsevier.com/legal/tdmrep-license","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"https://doi.org/10.15223/policy-017","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"stm-asf"},{"URL":"https://doi.org/10.15223/policy-037","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"stm-asf"},{"URL":"https://doi.org/10.15223/policy-012","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"stm-asf"},{"URL":"https://doi.org/10.15223/policy-029","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"stm-asf"},{"URL":"https://doi.org/10.15223/policy-004","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"stm-asf"}],"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"https://linkinghub.elsevier.com/retrieve/pii/S0735675726002123"}},"subtitle":[],"assertion":[{"name":"publisher","label":"This article is maintained by","value":"Elsevier"},{"name":"articletitle","label":"Article Title","value":"The prevalence of life-threatening diagnoses in emergency department patients with chest pain in a national group"},{"name":"journaltitle","label":"Journal Title","value":"The American Journal of Emergency Medicine"},{"name":"articlelink","label":"CrossRef DOI link to publisher maintained version","value":"https://doi.org/10.1016/j.ajem.2026.05.006"},{"name":"content_type","label":"Content Type","value":"article"},{"name":"copyright","label":"Copyright","value":"© 2026 Elsevier Inc. 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life-threatening conditions may be slightly underestimated.","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"warning","value":"The total encounter pool (13.7 million) reflects all ED visits; the chest pain cohort (951,152) is the relevant denominator for prevalence figures — clinicians should use the latter when applying these numbers as pre-test probabilities.","value_numeric":null}],"summaries":{"what_studied":"Prevalence of seven life-threatening diagnoses (ACS, PE, pneumothorax, TAD, esophageal rupture, pericardial tamponade, ruptured aortic aneurysm) among ED patients presenting with atraumatic chest pain across 141 U.S. EDs in 17 states from January 2021 to December 2024.","key_result":"Of 951,152 atraumatic chest pain visits, 5.5% (~1 in 18) had a life-threatening diagnosis. ACS was most common (4.5%), followed by PE (0.78%), pneumothorax (0.13%), TAD (0.09%), esophageal rupture (0.007%), pericardial tamponade (0.005%), and ruptured aortic aneurysm (0.002%). Higher prevalence was seen in older, male, commercially insured patients with higher-acuity triage levels who arrived by ambulance.","limitations":"- Retrospective, observational design using administrative/billing data — diagnosis accuracy depends on coding quality.\n- Single ED group (USACS) staffing 141 sites, which may limit generalizability to other U.S. health systems or regions.\n- No follow-up beyond the ED visit; missed diagnoses discharged home would not be captured.","practice_takeaway":"Clinicians can use these large-scale prevalence figures as pre-test probabilities when evaluating chest pain: roughly 1 in 22 patients has ACS, and TAD/esophageal rupture/tamponade are each far rarer than 1 in 1,000. Higher acuity triage, ambulance arrival, older age, and male sex should raise suspicion for life-threatening etiologies."}},{"doi":"10.1111/acem.70317","pmid":"42084455","title":"Characteristics and Short‐Term Outcomes of Patients With Acute Pulmonary Embolism Requiring Intubation","journal_title":"Academic Emergency Medicine","journal_issn":"1069-6563","published_at":"2026-05-05T00:00:00.000Z","url":"https://doi.org/10.1111/acem.70317","source_score":3,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-09","doi":"10.1111/acem.70317","days":"7","issn":"1069-6563","rank":"3","field":"Clinical Medicine","score":"3","category":"Emergency Medicine","categories":["Emergency Medicine"],"_categories":["Emergency Medicine"]},"pubmed":{"doi":"10.1111/acem.70317","title":"Characteristics and Short-Term Outcomes of Patients With Acute Pulmonary Embolism Requiring Intubation.","journal":"Academic emergency medicine : official journal of the Society for Academic Emergency Medicine","methods":"","results":"We included 51 patients. Within 30 min of intubation, seven (14%) patients had a new or increased vasopressor requirement, four (8%) suffered cardiac arrest, and 1 (2%) required ECMO. Within 3 h, 26 (51%) patients had a new or increased vasopressor requirement, six (12%) suffered cardiac arrest, and five (10%) required ECMO. Patients with a central PE (n = 29, 57%) were more likely to experience peri-intubation hemodynamic instability (OR 3.4, 95% CI [0.95, 13], p = 0.048). Patients who had right ventricular strain on CT (OR 3.7, 95% CI [1.01, 15], p = 0.043) or echocardiogram (OR 8.0, 95% CI [1.9, 42], p = 0.0014) were also more likely to experience hemodynamic instability.","abstract":"$31","keywords":["intubation","mechanical ventilation","outcomes","pulmonary embolism","venous thromboembolism"],"pubmed_id":"42084455","conclusions":"Peri-intubation hemodynamic deterioration occurs in more than half of patients with acute PE, and severe events, like cardiac arrest, are common. Physicians should be cautious when intubating PE patients. Further research is needed to identify optimal strategies to treat PE patients who require intubation.","publication_date":"2026-05-05T00:00:00"},"crossref":{"DOI":"10.1111/acem.70317","URL":"https://doi.org/10.1111/acem.70317","ISSN":["1069-6563","1553-2712"],"link":[{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/acem.70317","content-type":"application/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https://onlinelibrary.wiley.com/doi/full-xml/10.1111/acem.70317","content-type":"application/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/acem.70317","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":"5","score":1,"title":["Characteristics and Short‐Term Outcomes of Patients With Acute Pulmonary Embolism Requiring Intubation"],"author":[{"given":"Isabel 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Within 3 h: 51% had new/increased vasopressor need, 12% had cardiac arrest, 10% required ECMO. Central PE (OR 3.4), RV strain on CT (OR 3.7), and RV strain on echo (OR 8.0) were each associated with higher odds of hemodynamic instability.","limitations":"Single-center retrospective design with only 51 patients limits generalizability and statistical power. PERT activation as inclusion criterion may select for higher-acuity cases, introducing selection bias. No control group of non-intubated PE patients for comparison.","practice_takeaway":"Clinicians should anticipate hemodynamic collapse when intubating PE patients — especially those with central clot or RV strain on imaging — and prepare vasopressors, resuscitation resources, and ECMO backup in advance. 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Major bleeding at 7 days was 4.1% vs. 2.2% (P=0.32); no intracranial hemorrhage occurred in either group.","limitations":"- Industry-funded (Boston Scientific), which may introduce bias.\n- Short 7-day primary outcome window limits conclusions about longer-term benefits (e.g., chronic thromboembolic disease, functional outcomes).\n- Open-label intervention (blinded adjudication only), raising risk of performance bias.","practice_takeaway":"For intermediate-risk PE patients with RV dilation, troponin elevation, and ≥2 signs of cardiorespiratory distress, adding USCDF with alteplase to anticoagulation significantly cuts the risk of early decompensation without a statistically significant increase in major bleeding. Clinicians should weigh this benefit against the modest absolute bleeding risk increase (~2%) when selecting candidates for catheter-directed therapy."}},{"doi":"10.1056/nejme2603115","pmid":"41910326","title":"Advanced Therapy for Intermediate-Risk Pulmonary Embolism","journal_title":"New England Journal of Medicine","journal_issn":"0028-4793","published_at":"2026-03-28T00:00:00.000Z","url":"https://doi.org/10.1056/nejme2603115","source_score":231,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-29T13:23:17.223Z","updated_at":"2026-05-29T13:23:17.223Z","tags":[{"paper_doi":"10.1056/nejme2603115","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1056/nejme2603115","tag_type":"category","value":"Medicine, General & Internal","value_numeric":null},{"paper_doi":"10.1056/nejme2603115","tag_type":"condition","value":"Pulmonary Embolism","value_numeric":null},{"paper_doi":"10.1056/nejme2603115","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1056/nejme2603115","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1056/nejme2603115","tag_type":"modality","value":"Anticoagulation","value_numeric":null},{"paper_doi":"10.1056/nejme2603115","tag_type":"modality","value":"Catheter-Directed Therapy","value_numeric":null},{"paper_doi":"10.1056/nejme2603115","tag_type":"modality","value":"Thrombolysis","value_numeric":null},{"paper_doi":"10.1056/nejme2603115","tag_type":"study_design","value":"Editorial","value_numeric":null},{"paper_doi":"10.1056/nejme2603115","tag_type":"warning","value":"Key result and sample size tags cannot be populated without access to the full text.","value_numeric":null},{"paper_doi":"10.1056/nejme2603115","tag_type":"warning","value":"This is an editorial (DOI: 10.1056/nejme2603115), not a primary research article — no original patient data, sample size, or quantitative outcomes are reported. 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The primary endpoint was change in RV/LV ratio at 48 hours; key secondary endpoints included 7‑day major adverse events.","key_result":"At 48 hours, mean RV/LV ratio reduction was 0.52±0.37 with CAVT versus 0.24±0.40 with anticoagulation, a difference of 0.27 (95% CI, 0.12–0.43). Earlier normalization of vital signs and major adverse event rates comparable to anticoagulation were reported.","limitations":"Small sample size (n=100) across 22 sites. Short follow-up for efficacy (48 hours) and safety (7 days), and the primary outcome was an imaging surrogate rather than longer-term clinical events.","practice_takeaway":"For adults with intermediate-high risk PE, adding CAVT to anticoagulation produced greater 48-hour RV unloading (larger RV/LV ratio reduction) with similar short‑term major adverse events compared with anticoagulation alone. 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Papers