A Systematic Review And Meta-Analysis

[Posted 17/May/2022]

AUDIENCE: Emergency Medicine, Pediatric

KEY FINDINGS: The present systematic review and meta-analysis showed that POCUS had high sensitivity and specificity for identifying testicular torsion in paediatric patients although the risk of bias was high in the studies analysed.

BACKGROUND: Previous studies have examined the utility of ultrasonography performed by radiologists for diagnosing paediatric testicular torsion. While point-of-care ultrasound (POCUS) is used in paediatric emergency medicine, its diagnostic accuracy is still unknown. The present systematic review and meta-analysis aimed to clarify the accuracy of POCUS in diagnosing testicular torsion in children.

DETAILS: Following the Preferred Reporting Items for Systematic Review and Meta-analysis of Diagnostic Test Accuracy guidelines, a systematic review was performed. Any study investigating the diagnostic accuracy of POCUS for paediatric testicular torsion was extracted. The primary outcome was the assessment of the diagnostic accuracy of POCUS for paediatric testicular torsion. The pooled sensitivity and specificity were calculated. Quality analysis was conducted using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Four studies enrolling 784 patients in total were included. The pooled sensitivity, specificity, and positive and negative likelihood ratios of POCUS were 98.4% (95% CI: 88.5% to 99.8%), 97.2% (95% CI: 87.2% to 99.4%), 34.7 (95% CI: 7.4 to 164.4) and 0.017 (95% CI: 0.002 to 0.12), respectively. Risk-of-bias assessment using QUADAS-2 revealed that two of the studies had a high risk of bias in patient selection.

Copyright © BMJ Publishing Group Ltd and the College of Emergency Medicine. All rights reserved.

Source: Mori, T., Ihara, T., Nomura, O. (2022). Diagnostic Accuracy Of Point-Of-Care Ultrasound For Paediatric Testicular Torsion: A Systematic Review And Meta-Analysis. Emergency Medicine Journal . 2022; e212281. Published: May 6, 2022. DOI: 10.1136/emermed-2021-212281.

PUBLIC HEALTH ALERT

Updated October 17, 2026 | Source: US Centers for Disease Control and Prevention (CDC)

[Posted 19/Oct/2026]

AUDIENCE: Infectious Disease, Internal Medicine

Key Surveillance Findings: According to the CDC, 4,410 confirmed measles cases were reported in the United States during 2026 as of October 15. Cases were reported across 47 jurisdictions, with 18 cases involving international visitors. The CDC recorded 42 new outbreaks during the year, and 96% of confirmed cases (4,228 of 4,410) were associated with outbreaks. This total includes cases linked to outbreaks that began in both 2025 and 2026.

The contrast with earlier years is marked. The United States reported 285 cases in 2024 and 2,289 in 2025. The current 2026 total reflects a significant increase in transmission and underscores the vulnerability of communities with inadequate immunization coverage.

Backround: The United States is experiencing a substantial resurgence of measles, with 4,410 confirmed cases reported as of October 15, 2026. The total has already exceeded the 2,289 cases recorded throughout 2025 by approximately 93%, highlighting the ongoing challenge of controlling a highly contagious, vaccine-preventable infection.

Declining Vaccination Coverage Raises Concern: Measles was declared eliminated in the United States in 2000, meaning sustained endemic transmission had been interrupted. However, imported infections can trigger outbreaks when the virus reaches susceptible populations.

National measles, mumps, and rubella (MMR) vaccination coverage among kindergarteners declined from 95.2% during the 2019-2020 school year to 92.4% in 2025-2026. The CDC estimates that approximately 280,000 kindergarteners were at risk during the 2025-2026 school year. Because measles spreads exceptionally efficiently, clusters of unvaccinated individuals can sustain transmission even in areas where overall vaccination coverage appears relatively high.

Two doses of MMR vaccine are approximately 97% effective against measles, compared with 93% effectiveness after one dose. Maintaining high coverage and identifying susceptible individuals remain central to preventing further spread.

Clinical and Public Health Implications

Clinicians should remain alert to possible measles in patients with compatible symptoms, particularly when there is a history of travel, known exposure, or residence in an affected community. Measles can cause serious complications, especially in infants and young children. Suspected cases require prompt infection-control precautions and coordination with public health authorities; patients should not be directed into routine waiting areas where others may be exposed.

Healthcare professionals should review patients’ immunization histories, recommend vaccination in accordance with current guidance, and reinforce the importance of protection before international travel. Public health teams should continue surveillance, contact tracing, and targeted vaccination efforts in communities with low coverage.

Key Takeaway

The rise to more than 4,400 confirmed cases in 2026 demonstrates that measles elimination does not eliminate the risk of renewed outbreaks. Sustained vaccination coverage, rapid recognition of suspected cases, and coordinated public health action are essential to limit transmission and protect vulnerable populations.

Data note: CDC surveillance figures are provisional and include confirmed cases reported by jurisdictions as of noon on Thursday, October 15, 2026. Counts may change as additional cases are confirmed. An outbreak is defined by the CDC as three or more related cases.

Copyright © Skyscape. All rights reserved.

Source: US Centers for Disease Control and Prevention. Measles Cases and Outbreaks. Updated October 16, 2026. CDC.

[Posted 16/Oct/2026]

AUDIENCE: General Surgery, Pediatrics, Emergency Medicine

KEY FINDINGS: The ENRICH-US trial did not demonstrate a significant overall reduction in length of stay from introducing a multifaceted implementation strategy. However, patients receiving a greater number of protocol elements experienced shorter hospital stays and fewer complications. These findings emphasize that the clinical benefit of enhanced recovery pathways may depend on consistent delivery of their components, not simply on adopting a protocol. Hospitals implementing pediatric ERPs should therefore monitor adherence alongside clinical outcomes and address organizational barriers that limit reliable implementation.

BACKGROUND: Enhanced recovery protocols (ERPs) combine evidence-based perioperative practices to support recovery, reduce opioid exposure, and minimize complications after surgery. Although these protocols are well established in adult surgical care, their implementation in pediatric populations has been slower. The ENRICH-US trial evaluated whether a structured implementation strategy could improve adherence to a pediatric gastrointestinal surgery ERP and enhance clinical outcomes.

DETAILS: This prospective, stepped-wedge cluster-randomized implementation-effectiveness trial included 597 patients aged 10-18 years undergoing elective gastrointestinal surgery at 18 US sites between September 2019 and June 2024. The protocol included 21 perioperative elements, supported by a structured implementation toolkit, multidisciplinary learning sessions, adherence feedback, and implementation reports. Outcomes were assessed during baseline usual care, implementation, and sustainability phases. The primary clinical outcome was postoperative hospital length of stay (LOS). Secondary outcomes included time to resumption of a regular diet, inpatient opioid use, postoperative complications, opioid prescriptions at discharge, 30-day readmission, and patient-reported health-related quality of life.

Inflammatory bowel disease was the most common surgical indication, accounting for 433 patients (72.5%). Across the three study phases, the implementation strategy did not significantly reduce overall hospital LOS or produce significant differences in most secondary outcomes. However, patients resumed a regular diet sooner and had lower opioid use during hospitalization as the protocol progressed. A patient-level analysis demonstrated the importance of adherence. Patients who received at least 13 ERP elements had a median hospital stay that was 1.14 days shorter (95% CI, -2.01 to -0.27) and lower odds of postoperative complications (adjusted odds ratio, 0.48; 95% CI, 0.28-0.82) than patients with lower adherence. The median number of protocol elements delivered increased from 11 during baseline to 14 during both implementation and sustainability phases (P < .001).

Copyright © Skyscape. All rights reserved.

Source: Raval, M. V., Tian, Y., Schäfer, W., et al. Implementation and Effectiveness of an Enhanced Recovery Protocol for Children Undergoing Surgery: The ENRICH-US Stepped-Wedge Cluster-Randomized Trial. JAMA Surgery. 2026; 161(7): 670-680. Published: October, 2026. DOI: 10.1001/jamasurg.2026.1382.

[Posted 13/Oct/2026]

AUDIENCE: Emergency Medicine, Geriatrics, Internal Medicine

KEY FINDINGS: This study suggests that frailty may provide clinically relevant information when assessing hospitalization needs in older adults presenting to the emergency department. The association was most apparent in patients assigned lower triage urgency categories, although the formal analysis did not confirm a statistically significant difference across categories.

Incorporating frailty assessment into geriatric emergency care may help clinicians consider functional vulnerability alongside acute illness severity. However, the findings are based on a single-center retrospective study and do not establish that frailty itself causes hospitalization. Further prospective, multicenter research is needed to clarify how frailty, social circumstances, clinical decision-making, and healthcare-system factors influence disposition.

BACKGROUND: Emergency department (ED) triage systems prioritize patients according to the urgency of their acute medical conditions. However, among older adults, frailty may also influence the need for hospitalization, even when patients have similar triage-assessed urgency. Understanding the relationship between frailty and hospital admission may help clinicians improve geriatric assessment and disposition decisions in emergency care.

DETAILS: This single-center retrospective cohort study was conducted at an urban tertiary hospital in Japan. Investigators analyzed emergency department visits by patients aged 65 years or older between November 2025 and March 2026. Frailty was defined as a score of 5 or higher on the Clinical Frailty Scale (CFS). Triage urgency was classified using the Japan Triage and Acuity Scale (JTAS). The primary outcome was hospitalization at the study hospital or transfer to another acute-care hospital. The investigators used mixed-effects logistic regression, adjusting for age, sex, mode of arrival, injury- or poisoning-related visits, living arrangements, and long-term care needs certification. The analysis also examined whether the association between frailty and hospitalization differed across triage categories.

The study included 3,127 emergency department visits, of which 1,526 resulted in hospitalization. Among patients in JTAS category 2, frailty was not significantly associated with hospitalization (adjusted odds ratio [OR], 1.00; 95% CI, 0.65–1.55). In category 3, frailty was associated with higher odds of hospitalization (OR, 1.54; 95% CI, 1.19–1.99). In the combined JTAS categories 4 and 5, the adjusted odds of hospitalization were approximately twice as high among frail patients (OR, 2.01; 95% CI, 1.13–3.58). The association between frailty and hospitalization appeared stronger in the lower-acuity categories. However, the overall interaction between frailty and triage category was not statistically significant (P = 0.091), so the study did not establish that the association differed across triage levels.

Copyright © Skyscape. All rights reserved.

Source: Hata, N., Nagae, M., and Umegaki, H. Frailty and Hospitalization After Emergency Department Evaluation Within Triage Categories in Older Patients: A Retrospective Cohort Study. Academic Emergency Medicine. 2026; 33(10). Published: August 22, 2026. DOI: 10.1111/acem.70419.

[Posted 12/Oct/2026]

AUDIENCE: Cardiology, Endocrinology, Internal Medicine

KEY FINDINGS: This study found that HF was associated with increased visceral adiposity, reduced muscle volume, and greater muscle fat infiltration, even when patients were compared with controls matched for BMI. The differing patterns across HF phenotypes suggest that body composition abnormalities are not uniform among patients with heart failure.

The findings indicate that BMI and conventional anthropometric measures may underestimate clinically relevant metabolic and muscular abnormalities. Advanced imaging and more consistent definitions of sarcopenia may improve characterization of these abnormalities, although further research is needed to determine their prognostic value and implications for treatment.

BACKGROUND: Heart failure (HF) is associated with metabolic and musculoskeletal abnormalities that may not be adequately captured by body mass index (BMI). Excess visceral fat, reduced skeletal muscle volume, and increased fat infiltration within muscle can coexist and may differ across HF phenotypes. This study used advanced imaging to characterize body composition in patients with HF compared with matched controls and to examine differences among HF with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF).

DETAILS: Researchers analyzed participants in the UK Biobank Imaging Study. A total of 185 individuals with HF and available ejection fraction measurements were matched in a 1:5 ratio with 925 controls matched for age, sex, and BMI. Whole-body magnetic resonance imaging (MRI) was used to quantify visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue, liver fat, thigh fat-free muscle volume, and muscle fat infiltration (MFI). Dual-energy x-ray absorptiometry (DXA) was used to measure total fat and appendicular lean mass. Personalized z-scores adjusted for sex and body size were calculated. Adverse muscle composition (AMC) was defined by the combination of low muscle volume and high muscle fat infiltration. The investigators also assessed sarcopenia using grip strength and DXA-derived lean mass criteria.

Compared with matched controls, participants with HF had significantly greater visceral adipose tissue (z-score, 0.46 ± 1.1 vs 0.07 ± 1.0; P < 0.001) and muscle fat infiltration (8.4% ± 2.3% vs 7.6% ± 2.0%; P < 0.001). Adverse muscle composition was present in 36% of participants with HF compared with 17% of controls (P < 0.001). Muscle volume was also lower in the HF group (z-score, −0.7 ± 1.0 vs −0.1 ± 0.9; P < 0.001). Body composition patterns differed across HF phenotypes. HFmrEF was associated with the highest visceral adipose tissue levels and lowest muscle volume. HFpEF showed greater overall fat and muscle fat infiltration, whereas HFrEF had the highest prevalence of adverse muscle composition and the weakest grip strength.

Despite the MRI-detected muscle abnormalities, the estimated prevalence of sarcopenia varied considerably according to the diagnostic criteria applied, highlighting inconsistencies among current definitions.

Copyright © Skyscape. All rights reserved.

Source: Butler, J., Fioretti, F., Anker, S. D., et al. Body Composition in Heart Failure: A Magnetic Resonance Imaging and Dual X-Ray Absorptiometry Assessment in the UK Biobank Study. JACC: Heart Failure. 2026; 14(10): 103242. Published: October, 2026. DOI: 10.1016/j.jchf.2026.103242.

A Paradigm for Healthy Aging

[Posted 6/Oct/2026]

AUDIENCE: Ob/Gyn, Endocrinology, Internal Medicine

KEY FINDINGS: Key Information The FIGO-IMS position paper reframes hormone therapy in POI and early menopause as replacement of prematurely lost ovarian hormones, with potential implications for healthy aging. Treatment decisions should consider age at ovarian insufficiency, symptoms, bone health, cardiovascular risk, uterine status, reproductive goals, and individual contraindications.

The evidence supports a comprehensive, individualized approach rather than assuming that regimens used for typical-age menopause are sufficient for younger women with prolonged estrogen deficiency. The authors also acknowledge important evidence gaps, particularly regarding long-term cardiovascular outcomes and comparative effectiveness of different hormone regimens.

BACKGROUND: Premature ovarian insufficiency (POI) and early menopause are associated with prolonged estrogen deficiency during years when ovarian hormone production would ordinarily continue. Beyond vasomotor symptoms and reproductive consequences, estrogen deficiency may affect skeletal, cardiovascular, metabolic, cognitive, and genitourinary health. Hormone therapy (HT) has traditionally been considered primarily for symptom control, but its role in replacing deficient ovarian hormones and supporting long-term health warrants broader clinical consideration.

A joint position paper from FIGO and the International Menopause Society (IMS) reviews current evidence and proposes a more comprehensive approach to hormone therapy in women with POI or early menopause.

DETAILS: The position paper examines the physiological rationale for estrogen replacement, the timing and duration of treatment, hormone formulation and route of administration, and the potential implications for bone and cardiovascular health. It discusses the distinction between hormone replacement in younger women with premature estrogen loss and conventional menopausal hormone therapy initiated around the usual age of menopause. The authors review evidence supporting physiological estradiol replacement, including transdermal 17β-estradiol at 100 micrograms per day or oral 17β-estradiol at 2-4 mg per day. The paper also addresses the need for progestogen protection in women with an intact uterus, individualization of treatment, fertility considerations, and the limitations of available evidence concerning long-term cardiovascular outcomes and comparisons between HT and combined oral contraceptives.

The position paper emphasizes that hormone therapy in women with POI or early menopause should be considered an important component of long-term health management, rather than solely a treatment for vasomotor symptoms. Physiological estrogen replacement may help maintain bone mineral density and address consequences of premature estrogen deficiency. The authors discuss evidence that transdermal estradiol at 100 micrograms per day can restore lumbar spine and femoral neck bone mineral density to normal levels in women with POI. However, evidence regarding the superiority of higher estrogen doses for all skeletal outcomes remains inconsistent, and comparative data on major cardiovascular outcomes are limited.

The paper also highlights the need for further research comparing hormone therapy with combined oral contraceptives and evaluating long-term health outcomes, treatment acceptability, and optimal regimens.

Copyright © Skyscape. All rights reserved.

Source: Benedetto, C., Khadilkar, S. S., Nappi, R. E., et al. Hormone therapy (HT) in women with premature ovarian insufficiency or early menopause: Time to think of a new paradigm for healthy aging. Journal of Gynecology & Obstetrics.. 2026; 175(1): 26-47. Published: October, 2026. DOI: 10.1002/ijgo.71217.