Emergency Medicine

ED delirium is common and predicts admission and 30‑day readmission

In a 2,827‑patient multisite retrospective ED cohort of adults ≥65, chart review identified delirium in 16.0% of encounters. Delirium was present in 27.3% of hospitalized older ED patients and in 7.9% of discharged patients. Delirium independently predicted hospital admission (aRR 1.54) and higher 30‑day readmission (19% vs 13%). ED management commonly used restraints and psychoactive drugs, while supportive care and prevention strategies were underutilized. 1

SENECA sepsis phenotypes lack external generalizability

This multisite retrospective study applied SENECA phenotypes to 3 European ED cohorts totaling over 30,000 encounters. Agreement with original SENECA phenotypes was poor (Cohen κ 0.32–0.40, Adjusted Rand Index 0.21–0.27). Phenotypes derived at each site also lacked consistency with one another, suggesting limited transportability. Authors conclude alternative methods are needed before clinical adoption of these phenotypes. 2

Delayed time to target MAP (≥12 h) associates with worse 90‑day survival in septic shock

Post hoc OPTPRESS analysis of 476 patients found TTT‑MAP ≥12 hours (or unreached) linked to higher 90‑day mortality (aOR 1.48; aHR 3.24). Shorter delays (1–12 hours) were not associated with higher mortality compared with <1 hour in the categorical analysis. Continuous modeling within patients who reached target within 24 hours showed no significant per‑hour mortality effect. Authors caution that TTT‑MAP measures first attainment, not total hypotension burden, so it does not define a safe hypotension duration. 3