Emergency Medicine Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped emergency medicine practice.

Chest Pain Risk Stratification

Safe early discharge from the ED

Admit-all → TIMI/GRACE → HEART score → hs-troponin 0/1h → safe discharge

Reducing unnecessary CT scans

CT-for-all → Canadian CT Head Rule (2001) → NEXUS II → PECARN

From SIRS to Sepsis-3

SIRS (1991) → Sepsis-3/qSOFA (2016) → Hour-1 bundle → lactate-guided

Making the ED safer for sedation

OR-only → ED propofol safety → ketofol → etomidate → discharge criteria

Ending opioid-first culture

Opioid-first → IV acetaminophen/ketorolac → ketamine subdissociative → multimodal