The task to choose the top five articles for 2025 from those published in JACEP Open is a daunting one, as the journal provides a breadth of article types from case reports to original research contributions. The range of articles makes the journal attractive for publication by seasoned, international, and young investigators alike. For this year, I have highlighted five articles that were either the most downloaded in 2025 or among the top five ever downloaded for the journal in its six-year history. The average number of downloads for these articles was greater than 3,000, which further demonstrates the importance of publishing articles that researchers and emergency clinicians find relevant.

1) Interobserver agreement between emergency clinicians and nurses for Clinical Opiate Withdrawal Scale

Original Research: This article evaluated the agreement between physicians and nurses for 120 patients using the Clinical Opiate Withdrawal Scale (COWS). This research demonstrated substantial agreement between physicians and nurses on COWS that allowed for expedited treatment of patients with buprenorphine on presentation to the emergency department.¹

2) Burnout, depression and stress in emergency department nurses and physicians and the impact on private and work life: A systematic review

Review: This is a systematic review of 893 articles evaluating physician and nursing burnout since 2020 in both English and German languages. Of these, 11 articles met the criteria for review. This article demonstrated a high prevalence of burnout for emergency physicians ranging from 50.7 to 71.4 percent. Overall, burnout showed a negative relationship to work-life balance and quality of life, while higher stress levels were associated with lower life satisfaction in emergency physicians.²

3) Sepsis resuscitation: Time to embrace a restrictive fluid strategy?

Letter to the Editor: This letter to the editor commented on a review article published in JACEP Open on sepsis management for patients in the emergency department and suggested a different management framework based on emerging literature with evidence for a restrictive fluid approach (4 mL/kg) along with vasopressor support. The popularity of this article highlights the importance of evidence-based discourse in the practice of medicine.³

4) Prehospital blood administration in traumatic hemorrhagic shock

Special Contribution (Emergency Medical Services): This special contribution provides an overview of critical elements needed to establish an out-of-hospital whole blood program for out-of-hospital patients with hemorrhagic shock. It addresses the current literature on the incorporation of such a treatment within EMS systems and highlights the importance of optimizing factors critical for trauma management, such as hemorrhage control, basic airway management, rapid on-scene intervention, and prompt transport to trauma centers.⁴