BACKGROUND: Prehospital procedures (PHP) by emergency medical services (EMS) are performed regularly in penetrating trauma patients despite previous studies demonstrating no benefit. We sought to examine the influence of PHPs on outcomes in penetrating trauma patients in urban locations where transport to trauma center is not prolonged. We hypothesized that patients without PHPs would have better outcomes than those undergoing PHP. METHODS: This was an Eastern Association for the Surgery of Trauma–sponsored, multicenter, prospective, observational trial of adults (18+ years) with penetrating trauma to the torso and/or proximal extremity presenting at 25 urban trauma centers. The impact of PHPs and transport mechanism on in-hospital mortality were examined. RESULTS: Of 2,284 patients included, 1,386 (60.7%) underwent PHP. The patients were primarily Black (n = 1,527, 66.9%) males (n = 1,986, 87.5%) injured by gunshot wound (n = 1,510, 66.0%) with 34.1% (n = 726) having New Injury Severity Score of ≥16. A total of 1,427 patients (62.5%) were transported by Advanced Life Support EMS, 17.2% (n = 392) by private vehicle, 13.7% (n = 312) by police, and 6.7% (n = 153) by Basic Life Support EMS. Of the PHP patients, 69.1% received PHP on scene, 59.9% received PHP in route, and 29.0% received PHP both on scene and in route. Initial scene vitals differed between groups, but initial emergency department vitals did not. Receipt of ≥1 PHP increased mortality odds (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.01–1.83; p = 0.04). Logistic regression showed increased mortality with each PHP, whether on scene or during transport. Subset analysis of specific PHP revealed that intubation (OR, 10.76; 95% CI, 4.02–28.78; p < 0.001), C-spine immobilization (OR, 5.80; 95% CI, 1.85–18.26; p < 0.01), and pleural decompression (OR, 3.70; 95% CI, 1.33–10.28; p = 0.01) had the highest odds of mortality after adjusting for multiple variables. CONCLUSION: Prehospital procedures in penetrating trauma patients impart no survival advantage and may be harmful in urban settings, even when performed during transport. Therefore, PHP should be forgone in lieu of immediate transport to improve patient outcomes. LEVEL OF EVIDENCE: Prognostic, level III.

Background: Limited recent data exist on prescribing patterns and patient characteristics for glucagon-like peptide 1 receptor agonists (GLP-1 RAs), an important drug class used as anti-diabetic medication (ADM) for patients with type 2 diabetes mellitus (T2D) and/or anti-obesity medication (AOM) in patients with overweight or obesity. For brevity, we use the term GLP-1 RA to refer to both GLP-1 RA and dual GLP-1 RA/GIP medications. Objective: To describe recent trends in prescribing and dispensing of GLP-1-based medications in the US. Methods: Using a subset of real-world electronic health record (EHR) data from Truveta, a growing collective of health systems that provide more than 18% of all daily clinical care in the US, we identified people who were prescribed a GLP-1-based medication between January 01, 2019 and September 30, 2026. We describe prescribing volumes and patient characteristics over time, by medication, and by FDA-labeled use. Among the subset of patients for whom post-prescription dispensing data is available, we describe the proportion and characteristics of patients who were and were not dispensed a GLP-1 RA following their prescription. Results: 4,458,532 patients were prescribed a GLP-1 RA between January 2019 and September 2026, with 23,616,330 total prescriptions during this period. Overall prescribing rates (GLP-1 RA prescriptions as a proportion of all prescriptions) increased by 7.0% from June to September 2026. AOM prescribing increased by 12.2% (+0.38 percentage points), with the largest month-over-month increase occurring from June to July and prescribing remained relatively steady thereafter. On July 1, 2026, the Medicare GLP-1 Bridge Program was implemented to expand access to GLP-1 AOMs for Medicare beneficiaries by reducing out-of-pocket costs. The June-to-July increase coincided with the July 1 implementation of the Medicare GLP-1 Bridge and may reflect expanded access to GLP-1 RAs for weight management through the program. This increase was largely driven by AOM tirzepatide, for which prescribing increased by 16.9%. Although AOM orforglipron prescribing more than doubled (+112.2%), orforglipron still accounted for a small proportion of AOM prescriptions. Tirzepatide remained the most commonly prescribed GLP-1 RA, while semaglutide prescribing remained relatively stable. Among first-time prescriptions for which indication could be established, ADMs accounted for 62.6% and AOMs accounted for 37.4%. Overall, first-time prescribing increased from June to July before declining through August and September, with rates in September similar to June (-1.8%). First-time AOM prescribing also increased from June to July before declining, with rates in September remaining relatively stable compared with June (+3.7%). First-time AOM tirzepatide prescribing increased by 10.1% from June to September, while first-time AOM semaglutide prescribing decreased by 12.5%. Trends in Prescribing: Overall prescribing rates (GLP-1 RA prescriptions per total prescriptions) in September 2026 increased slightly relative to June 2026 (+6.99%). ADM prescribing showed slight month-to-month increases, however ADM prescribing in September 2026 are about the same June 2026 (+2.73%). Month-over-month AOM prescribing increased most from June to July 2026 and remained relatively steady through September 2026. Overall, there was a 0.38 percentage point increase compared with June 2026 (+12.2%). The largest increase came from AOM tirzepatide prescriptions (+16.9%), which accounted for most of the overall increase. AOM orforglipron prescribing more than doubled (+112.2%), although overall prescribing remained low at 0.12% in September 2026. The June-to-July increase in AOM prescribing coincided with the July 1 implementation of the Medicare GLP-1 Bridge and may reflect expanded access to GLP-1 RAs for weight management through the program. Tirzepatide remains the most commonly prescribed GLP-1 RA and continued to increase over the last quarter, particularly when prescribed for obesity, while semaglutide prescribing remained relatively stable. Trends in First-Time Prescribing: Overall first-time GLP-1 RA prescribing increased from June to July 2026, then declined in August and September. By September, first-time prescribing rates were similar to June (-1.81%). First-time prescribing of ADMs decreased in September 2026, relative to June 2026 (-10.85%). First-time AOM prescribing increased from June to July 2026, then declined and remained relatively steady through September. Overall, first-time AOM prescribing in September was similar to June (+3.66%). First-time AOM tirzepatide prescribing increased 10.1%, while AOM orforglipron prescribing nearly doubled (+83.0%), although overall first-time prescribing of AOM orforglipron remained low. Similar to overall prescribing, the June-to-July increase in first-time AOM prescribing coincided with the July 1 implementation of the Medicare GLP-1 Bridge and may reflect expanded access to GLP-1 RAs for weight management through the program. Trends in Dispensing: During the full time period, 69.9% of GLP-1 RA prescriptions had a dispense within 60 days of their prescription (e.g., were initiated within 60 days). For patients first prescribed an ADM in June 2026, 71.5% filled a GLP-1 RA within 60 days. Initiation rates for ADM GLP-1 RA are about the same in June 2026, relative to March 2026 (+0.16%). For patients first prescribed an AOM in June 2026, 44.9% filled a GLP-1 RA within 60 days. Initiation rates for AOM GLP-1 RA are about the same in June 2026, relative to March 2026 (+2.48%). About this report: This report provides recent trends in the prescribing and dispensing of glucagon-like peptide-1 receptor agonist (GLP-1 RAs)-based medications, including dual GLP-1 RA/gastric inhibitory polypeptide (GIP) over time, by medication, and by FDA-labeled use. We used near real-time, aggregated electronic health record (EHR) data from a collective of US...

This study aimed to develop and temporally validate an electronic medical record (EMR)-based insomnia prediction model. In this nested case-control study, we analyzed EMR data from 2011–2018 obtained from a statewide health information exchange. The study sample included 19,843 insomnia cases and 19,843 controls matched by age, sex, and race. Models using different ML techniques were trained to predict insomnia using demographics, diagnosis, and medication order data from two surveillance periods: −1 to −365 days and −180 to −365 days before the first documentation of insomnia. Separate models were also trained with patient data from three time periods (2011–2013, 2011–2015, and 2011–2017). After selecting the best model, predictive performance was evaluated on holdout patients as well as patients from subsequent years to assess the temporal validity of the models. An extreme gradient boosting (XGBoost) model outperformed all other classifiers. XGboost models trained on 2011–2017 data from −1 to −365 and −180 to −365 days before index had AUCs of 0.80 (SD 0.005) and 0.70 (SD 0.006), respectively, on the holdout set. On patients with data from subsequent years, a drop of at most 4% in AUC is observed for all models, even when there is a five-year difference between the collection period of the training and the temporal validation data. The proposed EMR-based prediction models can be used to identify insomnia up to six months before clinical detection. These models may provide an inexpensive, scalable, and longitudinally viable method to screen for individuals at high risk of insomnia.