We studied 21,888 adult patients who underwent surgical treatment for TBI, such as a craniotomy, hematoma evacuation, or skull fracture repair, between 2010 and 2025 and compared outcomes for patients who received ketamine on the same day as their surgery and those who did not. We accounted for patient age, sex, race, ethnicity, socioeconomic vulnerability, TBI category, and emergency department acuity level. 

We found no significant difference in the likelihood of developing paralysis, seizures, or attention deficit disorder in the six months following surgery, and no significant difference in the likelihood of in-hospital death between patients who received ketamine on the day of surgery and those who did not. 

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 296 million patient records from 1,600 hospitals and more than 39,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

1. Facts about TBI. U.S. Centers for Disease Control and Prevention. June 18, 2024. https://www.cdc.gov/traumatic-brain-injury/data-research/facts-stats/index.html. Accessed February 13, 2025. 
2. Maas AIR, Menon DK, Adelson PD, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16(12):987-1048. doi:10.1016/s1474-4422(17)30371-x 
3. Richards ND, Howell SJ, Bellamy MC, Beck J. The diverse effects of ketamine, jack-of-all-trades: a narrative review. Br J Anaesth. 2025;134(3):649-661. doi:10.1016/j.bja.2024.11.018 
4. Godoy DA, Badenes R, Pelosi P, Robba C. Ketamine in acute phase of severe traumatic brain injury “an old drug for new uses?” Crit Care. 2021;25(1). doi:10.1186/s13054-020-03452-x 
5. Zanza C, Piccolella F, Racca F, et al. Ketamine in Acute Brain Injury: Current Opinion Following Cerebral Circulation and Electrical Activity. Healthcare (Basel). 2022;10(3):566. Published 2022 Mar 17. doi:10.3390/healthcare10030566 

To assess whether hurricane-affected populations experienced an increase in sinus infections, we examined encounters for either acute or chronic sinus infections in the six-week period following landfall of hurricanes Ian (2022), Nicole (2022), Idalia (2023), and Debby (2024).^5–8 We compared these periods to the same timeframe in the year before and after each hurricane. We compared Debby to the two years prior because it was too recent to compare to the year after. Our study population included residents of affected ZIP codes in Florida, Georgia, and South Carolina who had a healthcare encounter during the relevant study period. 

We found that the impact of hurricanes on sinus infection rates was minimal. Despite some minor fluctuations, we did not observe a consistent change in acute or chronic sinus infections in the weeks following any of the hurricanes studied compared to the years before and after. However, seasonal increases in sinus infection rates coincide with when hurricanes often make landfall and have a much more noticeable effect, as seen in Figures 1 and 2. 

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 296 million patient records from 1,600 hospitals and more than 37,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

1. Azimi P, Allen J. Respiratory health harms often follow flooding—taking these steps can help. Harvard Health Publishing. November 9, 2022. Accessed March 6, 2025. https://www.health.harvard.edu/blog/respiratory-health-harms-often-follow-flooding-taking-these-steps-can-help-202211092848 
2. BiologyInsights Team. Health risks from flooding after hurricanes. BiologyInsights. January 9, 2025. Accessed March 6, 2025. https://biologyinsights.com/health-risks-from-flooding-after-hurricanes/ 
3. Rath B, Young EA, Harris A, et al. Adverse respiratory symptoms and environmental exposures among children and adolescents following Hurricane Katrina. Public Health Rep. 2011;126(6):853-860. doi:10.1177/003335491112600611 
4. Oluyomi AO, Panthagani K, Sotelo J, et al. Houston hurricane Harvey health (Houston-3H) study: assessment of allergic symptoms and stress after hurricane Harvey flooding. Environ Health. 2021;20(1):9. Published 2021 Jan 19. doi:10.1186/s12940-021-00694-2 
5. National Hurricane Center. Tropical Cyclone Report: Hurricane Ian. National Oceanic and Atmospheric Administration. Updated April 3, 2023. Accessed March 6, 2025. https://www.nhc.noaa.gov/data/tcr/AL092022_Ian.pdf 
6. National Hurricane Center. Tropical Cyclone Report: Hurricane Nicole. National Oceanic and Atmospheric Administration. Updated March 17, 2023. Accessed March 6, 2025. https://www.nhc.noaa.gov/data/tcr/AL172022_Nicole.pdf 
7. National Hurricane Center. Tropical Cyclone Report: Hurricane Idalia. National Oceanic and Atmospheric Administration. Updated February 13, 2023. Accessed March 6, 2025. https://www.nhc.noaa.gov/data/tcr/AL102023_Idalia.pdf 
8. National Hurricane Center. Tropical Cyclone Report: Hurricane Debby. National Oceanic and Atmospheric Administration. Updated February 4, 2025. Accessed March 6, 2025. https://www.nhc.noaa.gov/data/tcr/AL042024_Debby.pdf. 

To better understand the relationship between GLP-1 use and diabetes-related outcomes in patients with T1D, we compared 7,010 adult patients with T1D who were prescribed GLP-1s and insulin to 304,422 adult patients with T1D who were on insulin alone.  

After taking into account patient demographics, BMI, HbA1c, smoking history, and hypertension, we found that patients with T1D who had no history of the given complication who used a GLP-1 medication were 55% less likely to have a hyperglycemia-related ED visit, 29% less likely to have a diabetic ketoacidosis (DKA)-related ED visit, and 26% less likely to have an amputation-related visit compared to those on insulin alone, as seen in Figure 1. While we saw some decrease in the rate of ED care for novel stroke, myocardial infarction (MI), hypoglycemia, or other T1D complications for those on GLP-1s, these findings were not statistically significant and might be due to random chance. It is important to note that the rates of new diabetic complications in one year for both groups were around 1%, indicating that these are uncommon outcomes regardless of medication use. 

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 296 million patient records from 1,600 hospitals and more than 39,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

1. Delrue C, Speeckaert MM. Mechanistic pathways and clinical implications of GLP-1 receptor agonists in type 1 diabetes management. Int J Mol Sci. 2024;25(17):9351. doi:10.3390/ijms25179351 
2. Li P, Li Z, Staton E, et al. GLP-1 Receptor Agonist and SGLT2 Inhibitor Prescribing in People With Type 1 Diabetes. JAMA Network. 2024;332(19):1667-1669. https://jamanetwork.com/journals/jama/article-abstract/2825312. Accessed February 4, 2025. 
3. Cornell S. A review of GLP-1 receptor agonists in type 2 diabetes: A focus on the mechanism of action of once-weekly agents. J Clin Pharm Ther. 2020;45 Suppl 1(Suppl 1):17-27. doi:10.1111/jcpt.13230 

We studied 50,980 patients diagnosed with pancreatic cancer between 2014 and 2024, excluding individuals with a cancer diagnosis of any type prior to their first documented symptom, sign, or abnormal lab. Time to diagnosis was calculated from the first recorded clinical finding known to be potentially associated with pancreatic cancer.  

The median time to diagnosis across all patients was 116 days, as seen in Figure 1. When stratified by demographic factors, we found that patients aged 85+ experienced the longest time to diagnosis, with a median of 143 days, while those aged 65-74 had the shortest median time to diagnosis of 108 days. The median time to diagnosis was longer for Hispanic and Black patients at 149 days, while those who were non-Hispanic had a median of 115 days and non-Black patients had a median of 111 days. Female patients experienced longer time to diagnosis, with a median of 129 days, compared to male patients, whose median time was 104 days.  

We further studied median time to diagnosis based on the category of the earliest clinical finding that could be associated with a pancreatic cancer diagnosis. Patients were represented in multiple categories if more than one indication was documented on the same day. Patients who had pancreatobiliary symptoms, such as jaundice, a pancreatic mass, or a pancreatic cyst, had the shortest median time to diagnosis at 6 days. Those who had imaging were diagnosed within 14 days. On the other hand, patients with less specific indications like cardiovascular symptoms, such as blood clots, or new onset of diabetes had much longer median times to diagnosis, with several months between the initial indication and diagnosis of pancreatic cancer. 

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 296 million patient records from 1,600 hospitals and more than 39,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

1. Can pancreatic cancer be found early? American Cancer Society. February 5, 2024. https://www.cancer.org/cancer/types/pancreatic-cancer/detection-diagnosis-staging/detection.html. Accessed February 5, 2025. 
2. Khalaf N, Liu Y, Kramer JR, El-Serag HB, Kanwal F, Singh H. Defining and understanding diagnostic delays among pancreatic cancer patients: A retrospective cohort study. Clin Gastroenterol Hepatol. 2025;23(1):179-181.e3. doi:10.1016/j.cgh.2024.07.006 

To better understand the demographics and clinical characteristics associated with cesarean deliveries, we studied 2,099,282 women who had their first delivery documented between January 1, 2017, and December 31, 2024. We excluded women who were younger than 14 years or older than 50 years at the time of birth or those whose baby had a gestational age less than 22 weeks or more than 45 weeks at delivery. 

We found that the rate of first-time deliveries by cesarean was highest amongst Black mothers, with 33.8% of their deliveries occurring by C-section, while Hispanic mothers had the lowest rate of C-sections for their first delivery, as seen in Figure 1. C-sections are more common in the South and Northeast regions of the US. However, those living in rural areas had lower rates of C-sections than those in more densely populated areas.  

We found similar results in a sensitivity analysis adjusting for factors known to increase the risk of cesarean deliveries, such as conditions of the placenta or umbilical cord, position of the baby, or medical diagnoses the mother may have. 

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 295 million patient records from 1,600 hospitals and more than 37,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

1. Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016 Feb 5;11(2):e0148343. doi: 10.1371/journal.pone.0148343. PMID: 26849801; PMCID: PMC4743929. 
2. Negrini R, da Silva Ferreira RD, Guimarães DZ. Value-based care in obstetrics: comparison between vaginal birth and caesarean section. BMC Pregnancy Childbirth. 2021;21(1). doi:10.1186/s12884-021-03798-2 
3. Caesarean section rates continue to rise, amid growing inequalities in access. World Health Organization. Published June 16, 2021. https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access. Accessed August 19, 2024. 
4. Mallenbaum C, Beheraj K. 1 in 3 births: C-section rate increases, again. Axios. Published April 29, 2024. https://www.axios.com/2024/04/29/c-section-rate-high-why-risks. Accessed August 19, 2024. 

To evaluate the vaccine’s effectiveness, we studied 348,376 patients tested for RSV between May 2023 and December 2024. These patients were either 75 or older or aged 60 to 74 and at increased risk. We adjusted for patient age, geographic region, rural or urban status, social vulnerability, history of influenza vaccination, smoking history, and BMI. For patients 75 or older, we also adjusted for an increased risk of a severe RSV infection. All patients had an RSV lab result. We matched each patient with an RSV vaccine to four patients who did not get an RSV vaccine, were tested for RSV in the same month, and were the same age as the vaccinated patient. 

We found that patients aged 60 to 74 who received the RSV vaccine were 73% less likely to have a medically attended RSV infection, 75% less likely to have an RSV-related ED visit, and 75% less likely to be admitted for RSV compared to those who did not receive the RSV vaccine. We also found similar rates of effectiveness in the 75 and older group, as shown in Figure 1. 

A sensitivity analysis of patients with RSV-like symptoms or an RSV diagnosis showed similar results. 

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 295 million patient records from 1,600 hospitals and more than 37,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

1. FDA approves first respiratory syncytial virus (RSV) vaccine. U.S. Food and Drug Administration. May 4, 2023. Accessed December 26, 2024. https://www.fda.gov/news-events/press-announcements/fda-approves-first-respiratory-syncytial-virus-rsv-vaccine. Accessed December 26, 2024. 
2. RSV vaccine guidance for older adults. U.S. Centers for Disease Control and Prevention. August 30, 2024. https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/older-adults.html. Accessed December 26, 2024. 

As healthcare organizations and policymakers consider ongoing investment and updating policies for care delivered through telehealth, we have launched a new data tracker to provide insight into trends in telehealth use over time and across a variety of specialties.  

Similar to what we found in our previous brief, mental health departments continue to provide care through telehealth at nearly three times the rates of most other specialties, with almost one-third of visits delivered through telehealth. We will continue to update this tracker regularly, so be sure to check back for the latest. 

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 296 million patient records from 1,600 hospitals and more than 37,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions.  

1. Epic Research. Expansion of Telehealth During COVID-19 Pandemic. Epic Research. https://epicresearch.org/articles/expansion-of-telehealth-during-covid-19-pandemic. Accessed on February 26, 2025.  
2. Fox B, Sizemore JO. As Office Visits Fall, Telehealth Takes Hold. Epic Research. https://epicresearch.org/articles/as-office-visits-fall-telehealth-takes-hold. Accessed on February 26, 2025. 
3. Fox B, Sizemore JO. Telehealth: Fad or the Future. Epic Research. https://epicresearch.org/articles/telehealth-fad-or-the-future. Accessed on February 26, 2025. 
4. Bartelt K, Piff A, Allen S, Barkley E. Telehealth Utilization Higher Than Pre-Pandemic Levels, but Down from Pandemic Highs. Epic Research. https://epicresearch.org/articles/telehealth-utilization-higher-than-pre-pandemic-levels-but-down-from-pandemic-highs. Accessed on February 26, 2025.  

We examined how often patients whose eGFR levels indicate they have stage 3 or higher CKD do not have a documented CKD diagnosis. We studied 681,583 patients with multiple creatinine labs at least 90 days apart whose calculated eGFR classified them as stage 3 or higher. Patients diagnosed with end-stage renal disease (ESRD) or those with a kidney transplant were excluded from this study, as transplant or dialysis procedures can interfere with eGFR values. 

We found that, while most patients had a CKD diagnosis documented when their eGFR results reflect CKD, females were nearly twice as likely to be undiagnosed as males, as seen in Figure 1. The highest undiagnosed rate was among women without diabetes (20.0%). 

Next, we evaluated how often the stage of the CKD diagnosis differed from the stage indicated by a patient’s eGFR results. We found that most patients have a diagnosed stage that matches their calculated stage, as seen in Figure 2. Patients classified as stage 5 were the least likely to have a staged diagnosis that matched their calculated stage. However, there were comparatively few patients with an eGFR indicating stage 5, and the exclusion of patients diagnosed with ESRD or who have had a transplant may disproportionately affect the rates observed among the stage 5 population. 

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 295 million patient records from 1,600 hospitals and more than 37,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

1. Chronic kidney disease in the United States, 2023. U.S. Centers for Disease Control and Prevention. May 15, 2024. https://www.cdc.gov/kidney-disease/php/data-research/index.html?. Accessed January 30, 2025. 
2. Fraser SD, Blakeman T. Chronic kidney disease: identification and management in primary care. Pragmat Obs Res. 2016;7:21-32. Published 2016 Aug 17. doi:10.2147/POR.S97310 
3. Testing for Chronic Kidney Disease. U.S. Centers for Disease Control and Prevention. May 15, 2024. https://www.cdc.gov/kidney-disease/testing/index.html. Accessed February 6, 2025. 

We studied 115,838 pregnancies in women with prior IUD use and 463,332 pregnancies in women without any documented history of birth control. We matched the two populations based on the mother’s age at conception, race, ethnicity, prior history of multiple births, height, and BMI. 

We found no meaningful difference in the rate of multiple gestation pregnancies between women with prior IUD use (1.79%) and those with no history of birth control use (1.84%), as seen in Figure 1. This finding held true for both hormonal and copper, or non-hormonal, IUDs. 

A sensitivity analysis adjusting for the matching features in a logistic regression had similar results.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 295 million patient records from 1,600 hospitals and more than 37,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

1. Stoddard AM, Xu H, Madden T, Allsworth JE, Peipert JF. Fertility after intrauterine device removal: a pilot study. Eur J Contracept Reprod Health Care. 2015;20(3):223-230. doi:10.3109/13625187.2015.1010639 
2. Gayatri M, Utomo B, Budiharsana M, Dasvarma G. Pregnancy resumption following contraceptive discontinuation: Hazard survival analysis of the Indonesia Demographic and Health Survey Data 2007, 2012 and 2017. PLoS One. 2022;17(2):e0264318. Published 2022 Feb 23. doi:10.1371/journal.pone.0264318 

We studied 2.7 million patients who had an influenza or COVID-19 vaccination or infection in 2022 or 2023. We adjusted for patient age, race, ethnicity, sex, smoking history, rural or urban status, history of infection or vaccination, and social vulnerability. We compared the likelihood of appendicitis or appendectomy in the 30 days following the vaccine or infection exposure to the same 30-day window one year prior. 

We found no statistically significant change in the likelihood of being diagnosed with appendicitis or having an appendectomy for patients who had a COVID-19 infection, COVID-19 vaccination, influenza infection, or influenza vaccination compared to those without the exposure, as seen in Figure 1.  

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 293 million patient records from 1,600 hospitals and more than 37,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

1. Georgakopoulou VE, Gkoufa A, Damaskos C, et al. COVID-19-associated acute appendicitis in adults. A report of five cases and a review of the literature. Exp Ther Med. 2022;24(1):482. Published 2022 Jun 1. doi:10.3892/etm.2022.11409 
2. Soltani S, Kesheh MM, Siri G, et al. The role of viruses in human acute appendicitis: a systematic literature review. Int J Colorectal Dis. 2023;38(1). doi:10.1007/s00384-023-04391-z 
3. Oganesyan A, Schäfer M, Lesh C. Acute appendicitis following the COVID-19 vaccine. J Surg Case Rep. 2022;2022(6):rjac295. doi:10.1093/jscr/rjac295