Upcoming JACEP Open Study Looks at Imaging in Prospective AISP Patients

Low levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) may help rule out acute infectious spinal pathology (AISP) in emergency department (ED) patients without confirmatory imaging, according to a study recently published in JACEP Open. In their conclusion, the authors wrote that further prospective studies may be indicated to validate the findings.

“An Assessment of C-Reactive Protein and Erythrocyte Sedimentation Rate in Ruling Out Acute Infectious Spinal Pathology in Emergency Department Patients: A Retrospective Cohort Study” was published in August. In the objectives for the retrospective study, lead author Scott Gutovitz, MD, and the research team pointed out that AISP, including discitis, osteomyelitis, spinal epidural abscess, and septic arthritis are rare, carry significant morbidity and mortality, and are difficult to diagnose.

CRP and ESR, they noted, are frequently elevated in AISP, although there are no consensus recommendations on using them.

This multicenter retrospective cohort study reviewed ED encounters from 2016–2019 across 186 hospitals to assess the sensitivity of ESR and CRP in ruling out AISP. Adult patients presenting with spinal pain who had both biomarkers tested and underwent spinal MRI were included.

After excluding patients with other conditions known to elevate inflammatory markers, the study analyzed 5,944 encounters (1,963 AISP cases and 3,981 controls).

Median ESR was significantly higher in patients with AISP compared to controls (56 vs. 18 mm/h, P<.001), as was CRP (6.4 vs. 2.0 mg/dL, P<.001). Receiver-operating curve analysis identified cutoffs of ESR ≤20 mm/h or CRP ≤1.2 mg/dL for 90 percent sensitivity, and ESR ≤12 mm/h or CRP ≤0.7 mg/dL for 95 percent sensitivity.

Using both biomarkers together (ESR ≤20 mm/h and CRP ≤1.0 mg/dL) achieved 98.9 percent sensitivity and a negative predictive value >99 percent.

The findings suggest that low ESR and CRP values can effectively rule out AISP, potentially reducing the need for MRI in low-risk patients.

ACEP25 Discounts, Free Anytime Access End July 31

Time is running out to grab an early bird discount and free ACEP education when you register for ACEP25. Register for the Sept. 7-10 conference by July 31 and get $100 off. Even better, ACEP will toss in a one-year subscription to ACEP Anytime when you hit that deadline and start planning your trip to Salt Lake City.

ACEP Anytime features emergency medicine education the way you want to consume it. Choose from more than 40 podcasts, 60 publications and nearly 1,000 videos delivered hundreds of EM topics.

ACEP Anytime allows you to enjoy ACEP25 without worrying if you miss a course. But you won’t want to miss what’s coming to Salt Lake City.

ACEP is excited to bring emergency physicians a behind the scenes look at “The Pitt,” which was recently nominated for 13 Emmy Awards for Season 1. Noah Wyle, along with writer and producer Joseph Sachs, MD, FACEP, and medical advisor Mel Herbert, MD, FACEP, are delivering an exclusive panel discussion, moderated by incoming ACEP President L. Anthony Cirillo, MD, FACEP.

Discover how they capture the chaos, intensity, and humanity of the emergency department with stunning realism and why the show has deeply resonated with emergency physicians across the country.

The exciting back-to-back session lineup kicks off ACEP25 Opening Day and also features Olympic Gold medalist figure skater Scott Hamilton, who will deliver “I’m a Healer” – Finding Strength and Purpose Amidst Challenges.”

Hamilton will share his inspiring journey of resilience—from childhood illness to cancer battles—offering a powerful message of perseverance, hope, and turning obstacles into opportunities. Emergency physicians don’t just treat patients—they restore hope, navigate chaos, and heal beyond the physical.

“I’m a Healer” celebrates the resilience, compassion, and unwavering dedication that defines emergency medicine.

ACEP Advocacy Leads to New Boarding Legislation

A new ACEP-developed bipartisan bill to address the boarding crisis has been introduced in the House of Representatives, with a Senate companion soon to follow. This important legislation is a direct result of ACEP advocacy and the latest in a series of major ACEPinitiatives to address the boarding crisis. Advocating for the Addressing Boarding and Crowding in the ED (ABC-ED) Act was a central part of this year’s Leadership and AdvocacyConference (LAC).

Now is the time to build off the LAC momentum and call for the prompt passage of this bill into law. 

Urge Your Legislator to Support the ABC-ED Act.

“Boarding in the emergency department is a national public health crisis that puts patient lives at risk and strains emergency physicians and care teams every day,” said Alison J.Haddock, MD, FACEP, President of ACEP.

This bill:

• Utilizes public health data modernization grants to support development and implementation of real-time, state- or region-wide hospital bed tracking and hospital capacity management systems with a focus on addressing boarding.
• Supports innovative care models through Medicare pilot programs – focused on improving geriatric emergency care and psychiatric emergency care, increasing bilateral communication and improving coordinated care.
• Commissions a GAO study to identify best practices for hospital capacity tracking and its effect on boarding, wait times, and EMS offload delays.

Read more about the bill here. Contact your legislators.

JACEP Open Study Finds Waiting Room Treatment Does Not Have Higher Rate of 72-Hour Returns

This is not the research Cynthia Gaudet, DO, ever imagined conducting when she first got into medicine. Dr. Gaudet and colleagues evaluated the rate of return visits to the emergency department (ED) within 72 hours of discharge for patients evaluated in the waiting room. Because of ED crowding challenges, they hypothesized that some patients may be suitable for the completion of evaluation without rooming.

Dr. Gaudet

“It’s disheartening, but this is where we are right now,” said Dr. Gaudet, an emergency physician at Beth Israel Deaconess Medical Center. “I worry about the impact it has on patients. Our group is looking into that as well.”

Published in the June 2025 issue of JACEP Open, researchers found no significant increase in the rate of return for patients seen primarily in the waiting room or for those where the initial work-up started in the waiting room compared with those who were placed in a treatment space prior to a physician evaluation. The retrospective study evaluated more than 1,500 patients seen at a single academic ED, comparing those who began care in standard treatment rooms with those initially evaluated in alternative care spaces because of ED crowding.

Key metrics included lab utilization, imaging, time to admission, and return visits. The conclusion: patients managed outside private rooms received comparable care.

“We wanted to understand the downstream effects of what is happening because of these trying times and the pressure in the emergency department,” said Dr. Gaudet, who also serves as Director of Quality Assurance at UMass Memorial Health – Harrington. “I think the emergency department gives us a unique lens into all the places that the hospital system and the medical system are breaking down. We become the catch-all for everyone that comes in the door.”

The way waiting room medicine is practiced varies. Some hospitals carve out evaluation zones in hallways or create temporary exam spaces off to the side. Others designate teams to circulate through the waiting room itself.

“Some places have a few feet in the hallway or an extra room to pull people in momentarily for a history and exam,” Gaudet explained. “Other times, you’re just trying to find a sliver of space to assess patients quickly.”

Gaudet emphasized that this should not become standard. “We’re not trying to normalize hallway care,” she said. “Our goal is to gather evidence, understand what’s happening, and hopefully make a case for change.”

Read the research in JACEP Open.

ACEP to Congress: Reject Medicaid Changes That Would Leave Millions Uninsured

ACEP recently joined 42 national medical organizations in a letter to express concern that drastic changes to Medicaid under consideration will disproportionately affect emergency departments (EDs) already under significant strain, leaving emergency physicians with fewer resources to respond to patient needs, and threatening patient access to lifesaving emergency care.

“Emergency departments are one of the few settings where patients are treated 24/7/365, regardless of their insurance status or ability to pay,” said ACEP President Alison Haddock, MD, FACEP. “The impact of policies that will leave millions of people without any health coverage falls squarely onto emergency physicians and patients. Patients with unmet health care needs will delay treatment and their conditions will worsen, leaving them with no other option than the ED. This creates avoidable health risks and threatens the viability of an already strained health care safety net.”

Under the provisions passed by the House of Representatives, the Congressional Budget Office projects an additional 7.6 million people will go without any health coverage, resulting in an additional $5.5 billion in losses for emergency physician payments.

“The very idea of emergency medicine as we now know it—lifesaving care available for anyone at any time—is under direct threat from these proposed policy changes,” said Dr. Haddock.

To read more, click here.