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Download the article PDF: Abstracts In Urgent Care January 2026
Prevention of RSV Disease in Healthy Infants
Take Home Point: In this early phase, drug-manufacturer-funded clinical trial, a single dose of clesrovimab reduced the incidence of respiratory syncytial virus (RSV)-associated medically attended lower respiratory infection and RSV-associated hospitalization, with a safety profile similar to that of a placebo.
Citation: Zar HJ, Simões E, Madhi S, et. al. Clesrovimab in Infants and Children at Increased Risk for Severe RSV Disease. New Eng J Med. 2025:393, 13;1292-1303.
Relevance: RSV is a common cause of morbidity and mortality in infants worldwide. Prevention utilizing monoclonal antibodies has recently been approved for use with some promising results.
Study Summary: This was a double-blind, randomized, placebo-controlled phase 2b–3 trial to evaluate the efficacy and safety of a single 105 mg dose of clesrovimab in infants in 22 countries. Infants recruited were healthy, under 1 year who had been born either early or moderately preterm (gestational age, 29 weeks to 34 weeks 6 days) or late preterm or full-term (gestational age, ≥35 weeks). They were randomly assigned in a 2:1 ratio to receive either a 105 mg intramuscular injection of clesrovimab or a placebo. The primary end point was RSV-associated medically attended (inpatient or outpatient) lower respiratory infection from days 1 to 150 after injection.
The authors recruited 3,614 infants: 2,412 infants received clesrovimab (including 1 who had been assigned to the placebo group but received clesrovimab), and 1,202 infants received placebo. They noted that lower respiratory infection was diagnosed in 60 of 2,398 infants in the clesrovimab group and in 74 of 1,201 infants in the placebo group (efficacy 60.4%; 95% confidence interval [CI], 44.1 to 71.9; P<0.001). RSV-associated hospitalization was reported in 9 of 2,398 infants in the clesrovimab group and in 28 of 1,201 infants in the placebo group (efficacy 84.2%; 95% CI, 66.6 to 92.6; P<0.001). The number of infants needed to be immunized to prevent 1 case of RSV infection through day 150 ranged from 15 (95% CI, 11 to 21) for RSV-associated acute respiratory infection to 108 (95% CI, 60 to 226) for RSV-associated severe medically attended lower respiratory infection. Adverse events were the same between the groups.
Editor’s Comments: This study is positive toward the use of clesrovimab, however, it does not include milder cases of infection where parents might choose self-management and supportive care. The safety and efficacy of the treatment was not compared with other RSV monoclonal antibodies nirsevimab. Clesrovimab has since been approved by the Food and Drug Administration for use in prevention of RSV infection in infants and is 1 of 2 RSV prevention treatments recommended for use by the Advisory Committee on Immunization Practices.
Multidisciplinary Approach for the Treatment of Low Back Pain
Take Home Point: A multidisciplinary approach including exercise appears to have some benefit in reducing disability, pain, fear avoidance, and improved quality of life when compared to modalities that do not include exercise.
Citation: Vega-Retuerta N, Sánchez-Parente S, Segura-Jiménez V. Effectiveness of multidisciplinary approaches including exercise to treat non-specific chronic low back pain: A systematic review and meta-analysis across multiple regions. Prev Med. 2025;199:108381. doi: 10.1016/j.ypmed.2025.108381
Relevance: Non-specific chronic low back pain (NSCLBP) is a very common presentation to urgent care (UC) and causes significant disability. Medications are commonly used to alleviate symptoms but have recently been shown to have limited efficacy. Therefore, a more holistic approach needs to be considered in management of these patients.
Study Summary: This was a systematic review and meta-analysis of present literature to assess the effectiveness of multidisciplinary interventions that incorporate exercise in improving health outcomes among individuals with NSCLBP. The authors included original articles published in peer-reviewed journals, in English or Spanish, with adults diagnosed with NSCLBP investigating interventions for the alleviation of symptoms. The literature search was conducted from 4 databases: EBSCOhost, PubMed, Web of Science, and Scopus.
The authors identified 31 articles for final review. They found that in multidisciplinary interventions, statistically significant improvements were observed in various health outcomes among intervention groups (IGs) compared to control groups (CGs). Disability improved in 9 out of 25 studies (34.5% of IGs), while pain showed notable reductions in 14 out of 26 studies (53.6 % of IGs). Overall, the meta-analysis reported significant pooled effective size in favor of the IGs in disability, pain, fear avoidance, quality of life, and perceived change, but not in depression, anxiety, or stress.
Editor’s Comments: There was marked heterogeneity in the included studies with multiple different exercise treatments, various tools to measure disability, additional end points, and lack of patient cohort standardization. The results of this study need to be taken with caution as a result. Despite these limitations, the trend toward recommending exercise and other nonpharmacological approaches for the management of NSCLBP has grown in recent years. While this evolving practice is promising, further research is necessary to fully validate and define nonpharmacological treatments for NSCLBP.
What Dose of Epinephrine Is Better for Anaphylaxis?
Take Home Point: This study demonstrated that for the treatment of anaphylaxis, an initial dose of 0.3 mg of intramuscular (IM) epinephrine was associated with an increased need for additional epinephrine or intubation compared with an initial dose of 0.5 mg.
Citation: Jackson C, Dillon R, Fleenor L, et. al. Retrospective comparison between 0.3 mg and 0.5 mg dosing of intramuscular epinephrine for anaphylaxis. Am J Emerg Med. 2025 Oct 10;99:270-275. doi: 10.1016/j.ajem.2025.10.020.
Relevance: Anaphylaxis is a life-threatening condition, and the most common first-line treatment is an intramuscular administration of 0.3 mg epinephrine, despite the current weight-based dosing guidance of 0.01 mg/kg of body weight (maximum dose of 0.5 mg for adults).
Study Summary: This retrospective cohort study evaluated patients that received IM epinephrine for anaphylaxis in a single healthcare organization comprised of a large urban academic medical center and three regional hospitals in Tennessee, USA. Patients with World Health Organization definition for anaphylaxis were included into the study. Chart review was done to determine the initial intramuscular epinephrine dosing—0.3 mg or 0.5 mg. The primary outcome reviewed was the incidence of escalation of care for anaphylaxis defined as additional epinephrine administration or intubation following initial treatment.
The authors identified 338 patients to analyze, with 254 patients receiving 0.3 mg and 84 patients receiving 0.5 mg IM epinephrine. They found escalation of care was more common in the 0.3mg group compared to the 0.5mg group (30% vs 7%, p<0.001). The most common escalation of treatment was an additional dose of IM epinephrine occurring in 23% of patients, followed by the initiation of an epinephrine infusion in 6%, and intubation in 2%. The secondary efficacy outcome of resolution of symptoms after the first IM epinephrine dose was more common in the 0.5mg group compared to the 0.3 mg group. Compared to patients who received an initial dose of 0.5 mg, patients who received an initial dose of 0.3 mg had a longer length of stay in the ED and a higher likelihood of hospital admission.
Editor’s Comments: There were some limitations of the study including the retrospective design, which has a risk of systematic bias, the reliance on accurate anaphylaxis diagnosis documentation by initial providers, and the lack of identification IM administration site (deltoid vs anterolateral thigh, which is better absorbed). Despite these limitations, the study underscores a notable gap in current clinical practice: There is a lack of adherence to weight-based dosing recommendations for IM epinephrine. Both Advanced Cardiac Life Support and Advanced Life Support guidelines advocate for a 0.5 mg dose in adults. This finding suggests that urgent care clinicians should critically assess their own practices and institutional policies to ensure they are consistent with established dosing guidelines and best practices for the management of anaphylaxis.
Artificial Intelligence For Nonexpert Use of Ultrasound to Detect DVT
Take Home Point: This study suggests an artificial-intelligence (AI)-guided point-of-care ultrasound with remote expert review for deep vein thrombosis (DVT) can be a safe and effective method to reduce the number of duplex ultrasound (DUS) scans needed.
Citation: Avgerinos E, Spiliopoulos S, Psachoulia F, et. al. Novel Artificial Intelligence Guided Non-expert Compression Ultrasound Deep Vein Thrombosis Diagnostic Pathway May Reduce Vascular Laboratory Venous Testing. Eur J Vasc Endovasc Surg. 2025;70(4):517-522. doi: 10.1016/j.ejvs.2025.04.070.
Relevance: The diagnosis of DVT in an ED setting occurs via a complex clinical pathway including risk stratification (Wells score), D-dimer testing, and DUS. This can be both time-consuming and resource intense.
Study Summary: This was a single centered cohort study based in Athens, Greece, where patients with suspected DVT received an AI-guided 2 region proximal compression ultrasound by non-ultrasound qualified healthcare professionals and a D-dimer blood test. Patients who had either a positive AI guided scan or an elevated D-dimer had a formal DUS. Those with negative AI guided scans and negative D-dimers were discharged without further follow-up. The AI-guided scan was performed with ThinkSono Guidance (ThinkSono GmbH, Potsdam, Germany), a mobile app that pairs with a handheld ultrasound device, ie, Clarius HD3 L7 linear ultrasound device running standard Clarius software (Clarius, Vancouver, B.C., Canada).
The authors reviewed 53 patients with complete scans for review, and 45 of 53 (85%) scans were assessed as compressible. All compressible examinations showed no evidence of DVT on D-dimer testing or DUS. The 8 remaining examinations were deemed incompressible by the reviewers and ultimately 6 were diagnosed with DVT on DUS. This resulted in a sensitivity of 100%, specificity of 95.7%, positive predictive value (PPV) of 75%, and negative predictive value (NPV) of 100% for the system.
Editor’s Comments: The small sample size and the single center base of the study may limit the result generalizability. This pilot study does highlight the potential benefits of AI-guided point of care ultrasound scanning and remote interpretation of the scans by experts, which could be applicable for UCs with limited local resources. The capacity for non-trained UC clinicians to utilize AI guidance to confidently rule out conditions such as DVT could streamline referral pathways, decrease unnecessary testing, and ultimately improve patient outcomes.
Sex and Gender Influences in Pediatric ED Visits for Headache
Take Home Point: In this study, there were minor differences observed between adolescent male and female patient diagnostic evaluation, primarily in terms utilization of emergency department resources.
Citation: Ohana Sarna Cahan L, Ben Hamo M, Edrees J, et. al. Gender influences on clinical decisions in pediatric emergency department headache visits. Am J Emerg Med. 2025 Sep 16;99:83-89. doi: 10.1016/j.ajem.2025.09.028.
Relevance: There have been several studies describing sex and gender-related differences in the diagnosis, practice, and outcomes of many medical conditions among both patients and providers. This study looked specifically at adolescents presenting with a headache complaint to a pediatric emergency department.
Study Summary: This was a retrospective observational cohort study conducted in an Israeli tertiary level 1 trauma medical center. Medical charts for all patients 10-17 years old were reviewed over the 13-year study period and screened for the term “headache” in the chief complaint section. Components of care were extracted from each chart. Multiple generalized linear regression analyses were performed to test whether the gender of the provider or the gender of the patient influenced the components of care provided.
The authors analyzed 1,915 encounters, with female patients accounting for 998 (52.1%) of visits. They found there were no significant differences in terms of the laboratory tests or imaging tests (ie, computed tomography and magnetic resonance imaging) ordered for pediatric ED (PED). Female PED patients were more likely to be sent for a subspecialty consultation (143 [14.3%; CI 12.2–16.7%]) as compared to male PED (94 [10.3%,CI 8.4–12.4%], p=0.028). Women providers, as compared to men providers, were more likely to order a blood chemistry test and psychiatric evaluation regardless of the patient’s sex. Many providers had increased rates of return visits to the PED for male patients (odds ratio: 2.00; 95% CI: 1.08–4.07)
Editor’s Comments: Limitations of this study include the reliance on documentation and review of electronic records, which may result in recording bias confounding factors due to variables in measurements. Additionally, it is not clear how they gathered the gender identification for the providers. The single center and tertiary PED setting may limit its generalizability. The study does highlight continued gender and sex differences in medical evaluation and treatment. Therefore, it is a reminder that UC clinicians need to be vigilant when conducting visits. Clinicians should strive to avoid allowing personal biases or misconceptions to influence their clinical decisions, ensuring that every patient encounter is approached with objectivity.
Accuracy of Translated Discharge Instructions Using Artificial Intelligence
Take Home Point: In this comparison of using AI vs a professional interpreter translation for discharge instructions, utilizing blinded translator review, the AI model produced translations that were largely noninferior to the professional interpreter for Spanish but underperformed in all other languages.
Citation: Martos M, Fields B, Finlayson S, et. al. Accuracy of Artificial Intelligence vs Professionally Translated Discharge Instructions. JAMA Netw Open. 2025 2;8(9):e2532312. doi: 10.1001/jamanetworkopen.2025.32312
Relevance: As global populations continue to change and diversify, there is a growing demand for multilingual capabilities within UC settings. The ability to deliver medical care and information in the patients’ preferred language is essential. This approach enhances the quality of care, encourages more equitable access to medical services, reduces disparities, and promotes inclusiveness in healthcare delivery.
Study Summary: This was a comparative effectiveness analysis study comparing translations by a neural machine translation model (2 Azure models, Microsoft Corp) against professional translators using patient-specific pediatric inpatient discharge instructions at a single center academic pediatric hospital in Seattle, Washington, USA. The discharge instructions were translated from English to Simplified Chinese, Somali, Spanish, and Vietnamese. Blinded certified bilingual interpreters compared the outputs.
The authors identified 148 sections from 34 discharge instructions for analysis. When comparing all 4 languages collectively, fluency, adequacy, and meaning of the AI translation was lower than that of the human professionals. AI performance varied based on language tested, with AI translations in Spanish found noninferior in adequacy and error severity, but fluency (3.82 vs 4.20; difference, 0.38; 95% CI, 0.23-0.53; P < .001) was significantly worse. AI translations were inferior in every category for Simplified Chinese, Somali, and Vietnamese.
Editor’s Comments: It is important to recognize that, like all forms of technology, AI translation models are continuously advancing. This study is limited in its generalizability as it utilized 2 AI translation models, focused on only 4 languages, and utilized inpatient pediatric discharge instructions. As such, it may not apply to other AI translation models, other languages, or outpatient/adult discharge instructions.
From a legal standpoint, Section 1557 of the Patient Protection and Affordable Care Act imposes restrictions on the use of automated translations for medical documents. Specifically, this legislation prohibits the use of automated translation without human review in certain circumstances. As a result, while AI and other automated translation tools can be valuable resources, their use in healthcare settings must still involve human intervention to ensure compliance with existing legal requirements.