PSHP 2026 Residency Conference

This study assessed whether low-dose versus high-dose intravenous (IV) methylprednisolone may affect clinical response in emergency department (ED) patients presenting with an acute asthma or COPD exacerbation and a high eosinophil count.  


This single-center, retrospective cohort study included adult patients who presented to the ED with an acute asthma or COPD exacerbation and received IV methylprednisolone with a baseline eosinophil count greater than or equal to 3% or 300 cells/mcL. Patients were stratified into two groups, low-dose versus high-dose (< 40 mg or >40 mg of IV methylprednisolone), based on the initial dose of steroid that was administered in the ED. The primary endpoint was to compare Intensive Care Unit (ICU)-free days within a 28-day period. Key secondary endpoints measured include baseline eosinophil count, supplemental oxygen, hospital length of stay, and patient disposition. Cumulative correctional insulin use within 72 hours of initial methylprednisolone administration was evaluated as a surrogate for dose-dependent steroid-related adverse effects.  


Among 50 patients, 25 received low-dose and 25 received high-dose corticosteroids in the ED. Mean ICU-free days at 28 days were similar between groups (27.9 ± 0.34 vs 27.5 ± 1.22; p =0.577). The high-dose group had a higher baseline eosinophil count (median 6.1% [500 cells/mcL] vs 4.3% [400 cells/mcL]) and more patients on supplemental oxygen at baseline (6 vs 3). Hospital length of stay was longer in the high-dose group (4.15 vs 3.57 days; p=0.638), and more patients required ICU admission (5 vs 1 patient; p=0.172). Additionally, cumulative correctional insulin use within 72 hours was higher in the high-dose group (median 22 [IQR 2.5-50]) vs 10 [IQR 1.5-61.5]). 


Low-dose IV methylprednisolone demonstrated similar outcomes to high-dose therapy. Patients receiving higher doses appeared more clinically complex at baseline, with higher eosinophil counts and greater oxygen requirements. No significant differences in patient outcomes were observed. This study may support lower corticosteroid dosing in eosinophilic exacerbations to reduce potential steroid-related harm while maintaining clinical effectiveness. 

Purpose: Tenecteplase (TNK) is guideline-recommended for acute ischemic stroke (AIS) but carries a risk of symptomatic intracranial hemorrhage (sICH). The purpose of this study is to analyze risk factors for sICH after TNK administration in AIS. 
Methods: This is a retrospective, IRB approved, observational analysis of hospitalized adults who received intravenous TNK for AIS. Key exclusion criteria include lack of repeat imaging, known factor deficiency, or clotting disorder. The primary objective is the incidence of sICH after TNK administration. Secondary objectives encompass: identifying factors associated with hemorrhagic conversion (time from last known normal to TNK administration, time from stroke activation to TNK administration, age > 80 years, NIHSS > 25 or <5, large vessel occlusion, underwent mechanical thrombectomy, smoker, atrial fibrillation, diabetes antiplatelet use and anticoagulant use within past 7 days) and incidence of completing CTH 24 hours after IV thrombolytic was given per protocol. 
Results: In the 153 patients included, 11 (7.2%) patients developed a sICH after receiving TNK. Age greater than 80 years (p=0.003), antiplatelet use (p=0.019), and NIHSS > 25 (p=0.042) were considered to be potential contributing factors recognized as an increased risk after receiving TNK. Interestingly, patients who received an anticoagulant within the 7 days preceding TNK therapy were associated with a lower risk of developing a sICH, although it was not statistically significant (p=1.000). Thirty patients (19.6%) did not receive a repeat CTH 24-hours after receiving TNK, which is required per hospital protocol for thrombolytic use in

Evaluate if time to first non-benzodiazepine antiseizure medication (ASM) correlates with the rate of intensive care unit (ICU) admissions in patients presenting with status epilepticus (SE) at Thomas Jefferson University Hospital (TJUH). 


This single-center, retrospective chart review included adult patients presenting with SE to the emergency department (ED) at TJUH between April 2022 and April 2024. Records from the electronic health record were reviewed for eligibility. The primary objective was ICU admission rates in patients receiving a non-benzodiazepine ASM <30 vs ≥30 minutes. Secondary outcomes included ED length of stay (LOS), ICU LOS, hospital LOS, progression to refractory SE, cases of intubation, guideline-directed ASM loading dose administered, administration as intravenous (IV) push vs IV piggyback, medication procurement source, and ED pharmacist presence. Categorical variables were analyzed using chi-square or Fisher’s exact tests, and continuous variables using the Mann-Whitney U test. Multiple logistic regression controlling for Acute Physiology and Chronic Health Evaluation II (APACHE II) score and time to ASM administration was conducted. 


A total of 202 patient encounters were reviewed, of which 110 met inclusion criteria. Majority of patients were African American males. Among these, 22 encounters received ASM within <30 minutes, with a median APACHE II score of 22.5 and GCS of 4, while 88 encounters received ASM ≥30 minutes, with a median APACHE II of 8.5 and GCS of 9. ICU admission occurred in 86.4% of the <30-minute group and 45.5% of the ≥30-minute group (OR 7.6, 95% CI: 2.1–27, p<0.001). Median time to ASM was 19.5 vs 102 minutes. Median ED LOS was 2.71 vs 4.49 hours, ICU LOS 3.97 vs 0 days, and hospital LOS 7.39 vs 3.73 days, respectively. Higher rates of intubation, full loading doses, and drug procurement via automated dispensing systems were seen in the <30-minute group. Logistic regression showed time to non-benzodiazepine ASM was not associated with ICU admission, but higher APACHE II scores were independently associated (OR 1.272, 95% CI: 1.179–1.398). 


Early non-benzodiazepine ASM use was linked to higher ICU admissions, but there was no association after controlling for disease severity. Disease severity, demonstrated by higher APACHE II scores, were independently associated with increased ICU admission rates, particularly in patients receiving ASM <30 minutes. Further studies are needed to clarify the relationship between ASM timing and ICU admissions.

Purpose: To evaluate the frequency and address any contributing factors associated with inappropriate empiric antibiotic prescribing in the Emergency Department (ED) based on national and institutional guidelines.
Methods: A retrospective record review was conducted at St. Mary Medical Center of electronic patient health records from January 1, 2025- June 30, 2025. Adults aged 18-89 years presenting to the ED with suspected or confirmed pneumonia (PNA) or urinary tract infection (UTI), who received pre-identified broad-spectrum antibiotics were included. The primary outcome looked at frequency of inappropriate empiric broad-spectrum antibiotic prescribing in the ED. Secondary outcomes included post ED antimicrobial course, hospital length of stay (LOS), and subgroup analyses of patients who met SIRS criteria and those with multidrug-resistant organism (MDRO) risk factors. Safety endpoints included adverse drug reactions and mortality. Initial treatment strategy was assessed based on the 2019 American Thoracic Society pneumonia guidelines, and 2010 Infectious Diseases Society of America UTI guidelines with local resistance pattern guidance.  
Results: Of the 166 patients included, 98 (59%) received antibiotics for PNA and 68 (41%) for UTI. Overall, 108 (65%) received inappropriate empiric antibiotics. In the inappropriate group, 71 (66%) met SIRS criteria, of which 1 (0.9%) had septic shock. Anti-MRSA antibiotics were discontinued in 57 (53%) patients, and antipseudomonal therapy was narrowed in 54 (50%) patients. Vancomycin was administered to 89 (54%) patients, despite only 16 patients meeting criteria for empiric MRSA coverage. Common MDRO risk factors were IV antibiotic use within 90 days and prior MDRO positive cultures within 1 year. The inappropriate group also had a longer mean LOS by 57 hours. Acute kidney injury occurred in 7 (6%) patients, and 3 (3%) patients died. 
Conclusion: Inappropriate empiric treatment was associated with providing unnecessary gram positive and gram-negative coverage, indicating a pattern of reflexive broad-spectrum prescribing. Targeted education on current national and institutional practice guidelines may reduce unnecessary broad-spectrum antibiotic use and reduce antimicrobial resistance. 

Purpose: Evaluate the impact of provider education on the initial selection of medications used to treat patients with escalating agitation in acute care settings to ensure staff and patient safety.
Methods: A two-phase retrospective chart review study evaluated the impact of provider education on medication selection for agitated patients aged 18 and older who required an institutional agitation alert and received stat medications for agitation. Phase one retrospectively identified these patients during a six-month period prior to the intervention. In phase two, providers received an educational presentation detailing the recommendations from an algorithm collaboratively created by clinical pharmacists and psychiatric providers for treatment of acutely agitated and violent patients. Post-education in phase two, a second retrospective chart review was conducted. The primary endpoint was the percentage of administered medications that were adherent to the algorithm. Secondary endpoints included percentage of medications considered first-line and second-line agents, and percentage of patient encounters that required a repeat agitation alert.
Results: A total of 88 agitation alerts from phase one and 30 from phase two were included in this study. The percentage of medications administered that were adherent to the institution’s guideline was 85.2% (109/128) in phase one and 89.5% (34/38) in phase two. In phase one, 63.3% (69/109) of these adherent medications were considered first line recommended agents, and 61.8% (21/34) in phase two. Of the medications that were adherent to the algorithm, 36.7% (40/109) were considered second line recommended agents in phase one, and 38.2% (13/34) in phase two. The percentage of repeat agitation alerts that met inclusion criteria per patient encounter in phase one was 20.5% (18/88) and 3.3% (1/30) in phase two.
Conclusion: Provider education did not affect the percentage of medications administered adherent to the algorithm or on medications considered first or second line. The percentage of repeat agitation alerts decreased following provider education. The findings are limited by minimal direct pharmacist input on medication selection. Future studies may explore the impact that pharmacists can make by providing real-time interventions during agitation alerts.

Purpose: This study aims to evaluate the effectiveness and safety of ketamine-propofol compared with propofol alone for procedural sedation in adult patients undergoing orthopedic reductions.
Methods: This single-center retrospective observational study included adults (≥18 years) undergoing orthopedic reductions with ketamine-propofol or propofol in the emergency department between September 2024 to September 2025. Patients were identified via electronic medical records. The primary endpoint was sedation efficacy, defined as successful first-attempt reduction confirmed by imaging without additional sedation. Secondary endpoints included site-specific reduction success, recovery time, emergency department length of stay, total weight-based sedative dose, and incidence of respiratory, cardiovascular, and rescue interventions. Continuous variables were analyzed using t-test or Mann-Whitney U test; categorical variables using chi-square or Fisher’s exact test (α=0.05).
Results: A total of 72 patients were included (ketamine-propofol n=14; propofol n=58). Propofol was associated with a higher first-attempt reduction success rate compared with ketamine-propofol (89% vs 64%, p=0.01). Site-specific reduction success was similar for shoulder (66.7% vs 88.0%, p=0.35), hip (66.7% vs 100%, p=0.33), or ankle reductions (100% vs 100%, p>0.9). Emergency department length of stay did not differ between groups (562 vs 429 minutes, p=0.26). Ketamine–propofol required a higher total sedative dose (2.3 vs 1.5 mg/kg, p=0.04). Procedural success rat