Updates from Emergency Medicine Journals

Emergency Medicine Infectious Disease Pediatric Emergency

Positive Blood Culture ≠ Bacteremia: New Decision Rule
February 3, 2026February 11, 2026

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A simple 4-factor clinical decision rule accurately distinguished true bacteremia from contaminants in children with positive blood cultures, achieving 99% sensitivity while potentially reducing unnecessary hospitalizations.

Source
Derivation and Validation of a Clinical Rule to Detect Bacteremia Versus Contaminants in Positive Pediatric Blood Cultures: A Retrospective Cohort Study. Ann Emerg Med. 2025 Dec;86(6):576-585. doi: 10.1016/j.annemergmed.2025.06.620. Epub 2025 Aug 14. PMID: 40810705.

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Critical Care Emergency Medicine Pediatric Emergency Technology

Not EXAKT-ly Correct – Pulse Ox & Skin Tone
February 2, 2026February 11, 2026

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In a large multicenter ICU study, five different pulse oximeter models overestimated oxygen saturation in patients with darker skin tones, leading to substantially higher false negative rates for hypoxemia.

Source
EXAKT Study Investigators. The impact of skin tone on performance of pulse oximeters used by NHS England COVID Oximetry @home scheme: measurement and diagnostic accuracy study. BMJ. 2026 Jan 14;392:e085535. doi: 10.1136/bmj-2025-085535. PMID: 41534914; PMCID: PMC12801414.

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Emergency Medicine Pediatric Emergency Psychiatry | Substance Use Toxicology

Repeat Naloxone Doses Increasing—Watch These Patients!
January 30, 2026January 31, 2026

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This retrospective analysis found an increased rate of repeat naloxone administration in US EDs from 2016–2022.

Source
Use of Multiple Naloxone Administrations in the Emergency Department: A Retrospective Claims-Based Analysis. J Emerg Med. 2025 Dec;79:111-122. doi: 10.1016/j.jemermed.2025.04.022. Epub 2025 May 8. PMID: 41129837.

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Emergency Medicine Health Policy Pain/Sedation/Procedure Pharmacy/Pharmacology

Emergency Opiate Use and Rx Way Down—2016 to 2022
January 29, 2026January 31, 2026

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From 2016 to 2022, the rates of opioid administration in the ED and opiates prescribed after ED visits declined.

Source
Decreasing Rates of Opioid Administration in the Emergency Department: Trends in National Opioid Prescribing Patterns From 2016 to 2022. J Emerg Med. 2025 Dec;79:577-590. doi: 10.1016/j.jemermed.2025.10.011. Epub 2025 Oct 10. PMID: 41242068.

Read More Emergency Opiate Use and Rx Way Down—2016 to 2022
Critical Care Emergency Medicine Imaging Neurosurgery Trauma

Timing Is Everything—A Repeat CT Protocol for TBI
January 28, 2026January 31, 2026

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Approaches to repeat CT scans in traumatic brain injuries (TBIs) are highly variable. This study recommends a risk-stratified approach based upon injury severity, patients’ clinical factors, and timing of initial CT.

Source
Timing Is Everything: A Systematic Review of Optimal Repeat Computed Tomography Protocols in Traumatic Brain Injury. J Neurotrauma. 2025 Nov 24. doi: 10.1177/08977151251401545. Epub ahead of print. PMID: 41293885.

Read More Timing Is Everything—A Repeat CT Protocol for TBI
Critical Care Emergency Medicine GI Pain/Sedation/Procedure

Left, Right, or Center? Best Location for Paracentesis
January 27, 2026January 31, 2026

Spoon Feed —
When using a midline approach to paracentesis, there were no instances of hemorrhage compared to lateral. However, there is fine print to consider before changing your practice…

Source
Lateral Versus Midline: A Retrospective Review of Paracentesis Site Location and Risk of Hemorrhagic Complication. Crit Care Med. 2025 Dec 1;53(12):e2698-e2705. doi: 10.1097/CCM.0000000000006883. Epub 2025 Sep 26. PMID: 41020659.

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Cardiology Critical Care Emergency Medicine Pediatric Emergency

Best Vagal Maneuver for SVT
January 26, 2026January 28, 2026

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The modified Valsalva maneuver is the most effective first-line vagal maneuver for stable supraventricular tachycardia, achieving higher conversion rates and reducing the need for intravenous antiarrhythmics without increasing adverse events.

Source
Pursuit of Optimal Vagal Maneuvers in Stable Supraventricular Tachycardia: A Network Meta-Analysis. West J Emerg Med. 2025 Nov 26;26(6):1667-1678. doi: 10.5811/westjem.47305. PMID: 41380061; PMCID: PMC12698150.

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Critical Care Emergency Medicine Pain/Sedation/Procedure Pediatric Emergency Trauma

Pigtail for Pediatric Hemothorax?
January 23, 2026January 24, 2026

Spoon Feed —
Pigtail catheters had a similar safety profile and rates of catheter failures compared to chest tubes for treatment of hemodynamically stable children with hemothorax or hemopneumothorax.

Source
Percutaneous pigtail catheter versus chest tube for the treatment of pediatric traumatic hemothorax: An Eastern Association for the Surgery of Trauma multicenter study. J Trauma Acute Care Surg. 2025 Dec 1;99(6):850-858. doi: 10.1097/TA.0000000000004775. Epub 2025 Sep 15. PMID: 40956282.

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Emergency Medicine Pediatric Emergency Surgery

The Case FOR Non-Op Appendicitis Treatment
January 22, 2026January 24, 2026

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Large multicenter trials show that nonoperative antibiotic management of acute uncomplicated appendicitis is a safe, effective, and cost-effective alternative to urgent appendectomy for many adults and children. See Editor’s note at the end for counterpoint.

Source
Nonoperative Treatment of Appendicitis and Implications for Emergency Department Management: A Narrative Review. Ann Emerg Med. 2025 Dec 4:S0196-0644(25)01283-1. doi: 10.1016/j.annemergmed.2025.09.035. Epub ahead of print. PMID: 41348058.

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Critical Care Emergency Medicine Infectious Disease Medicine/Geriatrics Pulmonary/Allergy

Another Positive Trial for Steroids and Pneumonia
January 21, 2026January 24, 2026

Spoon Feed —
This RCT demonstrated modest reduction in 30-day mortality for patients with community-acquired pneumonia (CAP) in Kenya who received a 10-day course of glucocorticoids.

Source
A Pragmatic Trial of Glucocorticoids for Community-Acquired Pneumonia. N Engl J Med. 2025 Dec 4;393(22):2187-2197. doi: 10.1056/NEJMoa2507100. Epub 2025 Oct 29. PMID: 41159889; PMCID: PMC12659994.

Read More Another Positive Trial for Steroids and Pneumonia