Friday, August 17, 2007

July EMA Abstracts

1. WEEKEND VERSUS WEEKDAY ADMISSION AND MORTALITY FROM MYOCARDIAL INFARCTION Kostis, W.J., et al, N Engl J Med 356(11):1099, March 15, 2007: Lower utilization of PCI and CABG immediately and short term. Slightly higher 30-day mortality (12.9 v. 12.0%). Key point: Have your MI during the week.
2. DIAGNOSTIC VALUE OF 64-SLICE MULTI-DETECTOR ROW CARDIAC CTA IN SYMPTOMATIC PATIENTS Muhlenbruch, G., et al, Eur Radiol 17(3):603, March 2007: Only moderate agreement in symptomatic, high risk patients compared to cath. Leads to some questions as to benefit in these high risk patients.
3. A RANDOMIZED CONTROLLED TRIAL OF MULTI-SLICE CORONARY COMPUTED TOMOGRAPHY FOR EVALUATION OF ACUTE CHEST PAIN Goldstein, J.A., et al, J Am Coll Card 49(8):863, February 27, 2007: 67% were normal and discharged, 8% clearly abnormal and went to cath, and 25% needed standard work-up. For low risk patients, this may be an interesting paradigm.
4. CLINICAL AND ECONOMIC IMPACT OF STRESS ECHOCARDIOGRAPHY COMPARED WITH EXERCISE ELECTROCARDIOGRAPHY IN PATIENTS WITH SUSPECTED ACUTE CORONARY SYNDROME BUT NEGATIVE TROPONIN Jeetley, P., et al, Eur Heart J 28(2):204, January 2007: Stress echo categorized more patients as low risk, but more of these patients had events (5% v. 3%, NS) on follow-up. This is not helpful.
5. LONG-TERM OUTCOME AFTER AN EARLY INVASIVE VERSUS SELECTIVE INVASIVE TREATMENT STRATEGY IN PATIENTS WITH NON-ST-ELEVATION ACUTE CORONARY SYNDROME AND ELEVATED CARDIAC TROPONIN T (THE ICTUS TRIAL): A FOLLOW- UP STUDY Hirsch, A., et al, Lancet 369:827, March 10, 2007: No advantage to immediate PCI in non-STEMI. Early increase in MI with early invasive management!
6. CARDIAC CATHETERISATION: RADIATION DOSES AND LIFETIME RISK OF MALIGNANCY Vijayalakschmi, K., et al, Heart 93:370, March 2007: Depending on type of study performed, radiation risk estimated excess cancer deaths range from 1 in 3000 to 1 in 9000.
7. PROBLEMS WITH USE OF COMPOSITE END POINTS IN CARDIOVASCULAR TRIALS: SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED TRIALS Ferreira-Gonzalez, I., et al, Br Med J 334:786, April 2007: Composite endpoints often include clinically insignificant endpoints, which often are the only differences between interventions. What appears to be a significant difference may not be so significant for real outcomes. Use caution when looking at studies with composite endpoint.
8. NEUROLOGIC SYMPTOMS IN TYPE A AORTIC DISSECTIONS Gaul, C., et al, Stroke 38:292, February 2007: Another study showing it is hard to diagnose TAD. More misdiagnosis if patients presents with neuro symptoms only. Higher mortality noted. Fatal event noted with TPA treatment. Bad disease.
9. CARDIOPULMONARY RESUSCITATION BY BYSTANDERS WITH CHEST COMPRESSION ONLY (SOS-KANTO): AN OBSERVATIONAL STUDY Nagao, K., et al, Lancet 369:920, March 17, 2007 : No differences in outcome noted with compression only bystander CPR compared to conventional CPR/MMR.
10. YIELD AND UTILITY OF RADIOGRAPHIC "SHUNT SERIES" IN THE EVALUATION OF VENTRICULO-PERITONEAL SHUNT MALFUNCTION IN ADULT EMERGENCY PATIENTS Griffey, R.T., et al, Emerg Radiol 13(6):307, March 2007: Only 3% had an abnormal shunt series with a normal CT. Unclear if any utility to doing shunt series.
11. THE EFFECT OF FRESH FROZEN PLASMA IN SEVERE CLOSED HEAD INJURY Etemadrezaie, H., et al, Clin Neurol Neurosurg 109:166, February 2007: Unfortunately the FFP group was worse to begin with and did worse. No benefit seen, and maybe FFP is worse.
12. SAFETY OF RAPID INTRAVENOUS VALPROATE INFUSION IN PEDIATRIC PATIENTS Morton, L.D., et al, Ped Neurol 36(2):81, February 2007: Small study. Seems to be safe.
13. SAFETY OF RAPID INTRAVENOUS LOADING OF VALPROATE Limdi, N.A., et al, Epilepsia 48(3):478, March 2007: Small study, seems to be safe. Frequent burning @ infusion site.
14. COMMUNITY-ONSET METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS SKIN AND SOFT TISSUE INFECTIONS: IMPACT OF ANTIMICROBIAL THERAPY ON OUTCOME Ruhe, J.J., et al, Clin Infect Dis 44:777, March 15, 2007: I&D seems to be effective even if abx choice wrong. Low failure rate. More study needed. Continue to use MRSA appropriate abx (i.e. clindamycin) in our population.
15. TIME SERIES ANALYSIS OF VARIABLES ASSOCIATED WITH DAILY MEAN EMERGENCY DEPARTMENT LENGTH OF STAY Rathlev, N.K., et al, Ann Emerg Med 49(3):265, March 2007: Number of ED admits, number of elective surgical cases and increased IP occupancy accounted for a lot of the variability in ED LOS – factors often outside the control of the ED. ED LOS is a hospital-wide issue!
16. THE EFFECT OF LOW-COMPLEXITY PATIENTS ON EMERGENCY DEPARTMENT WAITING TIMES Schull, M.J., et al, Ann Emerg Med 49(3):257, March 2007: 50% of patients in ED are ‘low complexity’. They had minimal impact on overall ED LOS and time for patients to be seen. This is not the ED LOS and overcrowding problem.
17. COST-EFFECTIVENESS ANALYSIS OF TREATMENT OPTIONS FOR ACUTE OTITIS MEDIA Coco, A.S., Ann Fam Med 5(1):29, January/February 2007: WASP or giving amoxicillin equally (and poorly) cost-effective.
18. CAN URINE CULTURES AND REAGENT TEST STRIPS BE USED TO DIAGNOSE URINARY TRACT INFECTION IN ELDERLY EMERGENCY DEPARTMENT PATIENTS WITHOUT FOCAL URINARY SYMPTOMS? Ducharme, J., et al, Can J Emerg Med 9(2):87, March 2007: No.
19. EFFICACY OF ALPHA-BLOCKERS FOR THE TREATMENT OF URETERAL STONES Parsons, J.K., et al, J Urol 177:983, March 2007: Meta-analysis showed alpha blockers increased passage of stones. TAKE HOME POINT: Use alpha-blockers (i.e. Flomax 0.4mg po qd) when discharging patients with ureteral stones!
20. THROMBOEMBOLIC COMPLICATIONS ASSOCIATED WITH FACTOR VIIA ADMINISTRATION Rhys Thomas, G.O., et al, J Trauma 62:564, March 2007: TAKE HOME POINT: Thromboembolic complications in 10% of treated patients, some fatal. Use extreme care when using this drug (Novo-7).
21. DROTRECOGIN ALFA (ACTIVATED) IN CHILDREN WITH SEVERE SEPSIS: A MULTICENTRE PHASE III RANDOMISED CONTROLLED TRIAL Nadel, S., et al, Lancet 369:836, March 10, 2007: TAKE HOME POINT: Xigris did not show benefit in children with severe sepsis. May be worse in kids under 2 months. Bad, even in this industry sponsored trial.
22. CLINICAL AND LABORATORY FEATURES, HOSPITAL COURSE, AND OUTCOME OF ROCKY MOUNTAIN SPOTTED FEVER IN CHILDREN Buckingham, S.C., et al, J Ped 150:180, February 2007: Most had fever and rash, but less than half had fever, rash and history of tick attachment. Often delayed diagnosis and treatment. Some bad outcomes.
23. DO PERIPHERAL BLOOD CULTURES TAKEN IN THE EMERGENCY DEPARTMENT INFLUENCE CLINICAL MANAGEMENT? Munro, P.T., et al, Emerg Med J 24:211, March 2007: Only 1.4% had true positive blood cultures. Only 0.18% had management changed based on ED blood culture results. Think before you order the blood culture.
24. LATE VS. EARLY CLAMPING OF THE UMBILICAL CORD IN FULL-TERM NEONATES: SYSTEMATIC REVIEW AND META-ANALYSIS OF CONTROLLED TRIALS Hutton, E.K., et al, JAMA 297(11):1241, March 21, 2007: Meta-analysis. Clamp cord immediately or wait 2 minutes. Answer: probably wait 2-minutes, but no clear answer despite 15 studies.
25. DOES THIS ADULT PATIENT HAVE SEPTIC ARTHRITIS? Margaretten, M.E., et al, JAMA 297(13):1478, April 4, 2007: ESR and CRP not helpful. Very high peripheral WBC (>25) increases risk. TAKE HOME POINT: If you want to know, tap the joint.
26. APPLICATION OF CLINICAL CRITERIA FOR ORDERING RADIOGRAPHS TO DETECT CERVICAL SPINE FRACTURES Moscati, R.M., et al, Am J Emerg Med 25:325, March 2007: Once again, clinical criteria are safe/effective/cost effective. Think before you order the c-spine series.
27. DOSE AND TIME-DEPENDENT EFFECTS OF CYCLOOXYGENASE-2 INHIBITION ON FRACTURE HEALING Simon, A.M., et al, J Bone Joint Surg 89A(3):500, March 2007: Animal model of femur fx shows impairment of healing if used early in post-fx period. TAKE HOME POINT: Avoid use of NSAIDS and COX-2i’s in acute fx patients.
28. ACUTE TREATMENT OF INVERSION ANKLE SPRAINS Jones, M.H., et al, Clin Orth Rel Res 455:169, February 2007: Systematic review indicates early mobilization rather than splinting, but patients prefer immobilization.
29. THE ROLE OF PELVIC MAGNETIC RESONANCE IN EVALUATING NONHIP SOURCES OF INFECTION IN CHILDREN WITH ACUTE NONTRAUMATIC HIP PAIN Karmazyn,T B., et al, Ped Orth 27(2):158, March 2007: Consider MR in kids with hip pain with either fever, increased ESR or elevated WBC and neg hip taps but look sick.
30. PRIMARY REPAIR VERSUS CONSERVATIVE TREATMENT OF FIRST-TIME TRAUMATIC ANTERIOR DISLOCATION OF THE SHOULDER: A RANDOMIZED STUDY WITH 10-YEAR FOLLOW-UP Jakobsen, B.W., et al, Arthroscopy 23(2):118, February 2007: Interesting study. Many conservatively treated patients had recurrences or other problems, with less seen in surgically treated patients.
31. ALTERNATING ANTIPYRETICS FOR FEVER REDUCTION IN CHILDREN: AN UNFOUNDED PRACTICE PASSED DOWN TO PARENTS FROM PEDIATRICIANS Wright, A.D., et al, Clin Ped 46(2):146, March 2007: No evidence to support alternating regimens, but it is often recommended by pediatricians from parents.
32. CLINICAL PREDICTORS OF OCCULT PNEUMONIA IN THE FEBRILE CHILD Murphy, C.G., et al, Acad Emerg Med 14(3):243, March 2007: No clinical criteria were sensitive enough to exclude occult pneumonia.
33. DO ALL INFANTS WITH APPARENT LIFE-THREATENING EVENTS NEED TO BE ADMITTED? Claudius, I., et al, Pediatrics 119(4):679, April 2007: Gest age < 37 wks, multiple events, age less than 1 month all require admission. All others would have done well, but very small initial study.
34. A RANDOMIZED, CONTROLLED TRIAL OF ACETAMINOPHEN, IBUPROFEN AND CODEINE FOR ACUTE PAIN RELIEF IN CHILDREN WITH MUSCULOSKELETAL TRAUMA Clark, E., et al, Pediatrics 119(3):460, March 2007: Ibuprofen tended to have better pain relief than Tylenol or codeine.
35. SHOULD PULMONARY EMBOLISM BE SUSPECTED IN EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE? Rutschmann, O.T., et al, Thorax 62:121, February 2007: 3.3% of patients had PE when no other source of exacerbation was identified. Consider D-Dimer in these patients and look further (Dopplers and CT) if positive.
36. OPIATE THERAPY IN CHRONIC COUGH Morice, A.H., et al, Am J Resp Crit Care Med 175(4):312, February 15, 2007: Moderate improvement in well done study with morphine for chronic cough (5mg bid).
37. ANTIBIOTICS FOR BACTEREMIC PNEUMONIA: IMPROVED OUTCOMES WITH MACROLIDES BUT NOT FLUOROQUINOLONES Metersky, M.L., et al, Chest 131(2):466, February 2007: Macrolides had decreased mortality and readmission, and were better than fluoroquinolones and tetracycline.
38. PROPER INSERTION DEPTH OF ENDOTRACHEAL TUBES IN ADULTS BY TOPOGRAPHIC LANDMARKS MEASUREMENTS Evron, S., et al, J Clin Anesth 19(1):15, February 2007: Add distance from angle of mouth to angle of jaw and angle of jaw to midline of manubrium, positioned better than 21 cm for women and 23 cm for men. I won’t start doing this, as no actual clinical benefit noted.
39. SUGAMMADEX REVERSAL OF ROCURONIUM-INDUCED NEUROMUSCULAR BLOCKADE: A COMPARISON WITH NEOSTIGMINE-GLYCOPYRROLATE AND EDROPHONIUM-ATROPINE, Sacan, O., et al, Anesth Analg 104(3):569, March 2007: Reversal of nmb with this drug was faster than with neostigmine/glycopyrrolate or edrophonium. Nice tool to have, but probably won’t be used in the ED.
40. PROPHYLACTIC ANTIBIOTICS ARE NOT INDICATED IN UNCOMPLICATED HAND LACERATIONS, Al-Nammari, S.S., Emerg Med J 24:218, March 2007: The title says it all.

0 Comments:

Post a Comment

<< Home