July 2016 EM Articles

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Determination of a Testing Threshold for Lumbar Puncture in the Diagnosis of Subarachnoid Hemorrhage after a Negative Head CT: A Decision Analysis.
Acad Emerg Med. 2016 Jul 5. doi: 10.1111/acem.13042. [Epub ahead of print]
Spoon Feed: Unless your patient population has a much higher prevalence of disease that the Perry study and the meta-analysis last month, a negative head CT effectively rules out SAH.

Tweet Now, See You In the ED Later? Examining the Association Between Alcohol-related Tweets and Emergency Care Visits.
Acad Emerg Med. 2016 Jul;23(7):831-4. doi: 10.1111/acem.12983. Epub 2016 Jun 20.
Spoon Feed: A higher number of alcohol-related tweets correlates with an increased in ED visits for alcohol-related problems.

Validation of the bacterial meningitis score in adults presenting to the ED with meningitis.
Am J Emerg Med. 2016 Jul;34(7):1265-7. doi: 10.1016/j.ajem.2016.04.003. Epub 2016 Apr 7.
Spoon Feed: You can apply the Bacterial Meningitis Score to adults as well as kids, but also use common sense and err on the side of admission and treatment is there is any doubt.

Glasgow Coma Scale Motor Component ("Patient Does Not Follow Commands") Performs Similarly to Total Glasgow Coma Scale in Predicting Severe Injury in Trauma Patients.
Ann Emerg Med. 2016 Jul 16. pii: S0196-0644(16)30295-5. doi: 10.1016/j.annemergmed.2016.06.017. [Epub ahead of print]
Spoon Feed: GCS-motor only predicted as well as the full GCS score.

A Population-Based Analysis of Outcomes in Patients With a Primary Diagnosis of Hypertension in the Emergency Department.
Ann Emerg Med. 2016 Jul 1. pii: S0196-0644(16)30165-2. doi: 10.1016/j.annemergmed.2016.04.060. [Epub ahead of print]
Spoon Feed: ED visits solely for hypertension have very low adverse events rates shortly after ED discharge.

Effectiveness of EDACS Versus ADAPT Accelerated Diagnostic Pathways for Chest Pain: A Pragmatic Randomized Controlled Trial Embedded Within Practice.
Ann Emerg Med. 2016 Jul;68(1):93-102.e1. doi: 10.1016/j.annemergmed.2016.01.001.
Spoon Feed: ADAPT and EDACS performed the same for low-risk chest pain in this RCT.

Poor Outcomes After Emergency Department Discharge of the Elderly: A Case-Control Study.
Ann Emerg Med. 2016 Jul;68(1):43-51.e2. doi: 10.1016/j.annemergmed.2016.01.007. Epub 2016 Mar 2.
Spoon Feed: If you change your disposition decision and discharge an elderly patient after initially deciding to admit them, this is associated with bad outcomes.

Isopropyl Alcohol Nasal Inhalation for Nausea in the Emergency Department: A Randomized Controlled Trial.
Ann Emerg Med. 2016 Jul;68(1):1-9.e1. doi: 10.1016/j.annemergmed.2015.09.031. Epub 2015 Dec 8.
Spoon Feed: Sniffing an alcohol pad significantly reduced nausea short term.  Aromatherapy in the ED.

Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records.
BMJ. 2016 Jul 4;354:i3410. doi: 10.1136/bmj.i3410.
Spoon Feed: Decreased antibiotic use for respiratory tract infection does not cause an increase in infectious complications.

Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU: A Single-Center, Randomized Controlled Trial.
Crit Care Med. 2016 Jul 14. [Epub ahead of print]
Spoon Feed: Chlorhexidine baths reduced iatrogenic infection in this surgical ICU study.

Acetaminophen-Induced Changes in Systemic Blood Pressure in Critically Ill Patients: Results of a Multicenter Cohort Study.
Crit Care Med. 2016 Jul 13. [Epub ahead of print]
Spoon Feed: Acetaminophen IV may cause a drop in blood pressure when given to critically ill patients.

Posterior reperfusion T-waves: Wellens' syndrome of the posterior wall.
Emerg Med J. 2016 Jul 29. pii: emermed-2016-205852. doi: 10.1136/emermed-2016-205852. [Epub ahead of print]
Spoon Feed: With posterior MI reperfusion, the T-wave in V2 get bigger than non-posterior MI and V2 and V3 increase in size from baseline.  Why?  It's like Wellen's warning in reverse!

External validation of the emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP).
Emerg Med J. 2016 Jul 12. pii: emermed-2015-205028. doi: 10.1136/emermed-2015-205028. [Epub ahead of print]
Spoon Feed: The EDACS accelerated diagnostic protocol for low risk chest pain performed well in this retrospective look.  But EDACS classifies some patients as "low-risk" that I wouldn't consider low, such as a patient > 65 years with known CAD.

Risk of Delayed Intracranial Hemorrhage in Anticoagulated Patients with Mild Traumatic Brain Injury: Systematic Review and Meta-Analysis.
J Emerg Med. 2016 Jul 26. pii: S0736-4679(16)30175-5. doi: 10.1016/j.jemermed.2016.05.045. [Epub ahead of print]
Spoon Feed: Risk of a delayed intracranial bleed on warfarin at 24 hours was 0.6% in this meta-analysis.

Questioning Use of an Age-Adjusted D-Dimer Threshold to Exclude Venous Thromboembolism: Analysis of Individual Patient Data from Two Diagnostic Studies.
J Thromb Haemost. 2016 Jul 25. doi: 10.1111/jth.13424. [Epub ahead of print]
Spoon Feed: Age adjusted D-dimer is still valid despite this study.

Cervical Spinal Clearance: A Prospective Western Trauma Association Multi-Institutional Trial.
J Trauma Acute Care Surg. 2016 Jul 20. [Epub ahead of print]
Spoon Feed: Unless the neurological exam was abnormal, CT c-spine detected all clinically significant cervical spine injuries.

Early Antibiotic Treatment for Pediatric Febrile Urinary Tract Infection and Renal Scarring.
JAMA Pediatr. 2016 Jul 25. doi: 10.1001/jamapediatrics.2016.1181. [Epub ahead of print]
Spoon Feed: You have 48 hours to start antibiotics to prevent renal scarring in pediatric patients. Antibiotics  >72 hours was associated with scarring.

Effect of Ondansetron on QT Interval in Patients Cared for in the PICU.
Pediatr Crit Care Med. 2016 Jul;17(7):e317-23. doi: 10.1097/PCC.0000000000000776.
Spoon Feed: QTc is not affected in non-critical pediatric patients getting ondansetron, but in this critically ill population, about one third had significant QTc prolongation.

Validation of the "Step-by-Step" Approach in the Management of Young Febrile Infants.
Pediatrics. 2016 Jul 5. pii: e20154381. [Epub ahead of print]
Spoon Feed: A stepwise approach to febrile infant <90 days had high sensitivity and NPV and was superior to the Rochester Criteria and Lab-score.

Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016.
Pediatrics. 2016 Jul;138(1). pii: e20161212. doi: 10.1542/peds.2016-1212.
Spoon Feed: The new pediatric sedation guidelines made ridiculously simple on the Article a Day blog.

Extended- Versus Narrower-Spectrum Antibiotics for Appendicitis.
Pediatrics. 2016 Jul;138(1). pii: e20154547. doi: 10.1542/peds.2015-4547.
Spoon Feed: Narrow or broad spectrum antibiotic choice has little impact on pediatric appendicitis outcome.  Broader coverage may, in fact, be worse.

Isolated fat pad sign in acute elbow injury: is it clinically relevant?
Eur J Emerg Med. 2016 Jun;23(3):228-31. doi: 10.1097/MEJ.0000000000000288.
Spoon Feed: Isolated posterior fat pad on x-ray for adults heals great even if you do nothing.

Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study.
Eur Heart J. 2016 Jun 28. pii: ehw230. [Epub ahead of print]
Spoon Feed: Procainamide beat amiodarone for stable VT in this RCT.

Ondansetron in pregnancy and risk of adverse fetal outcomes in the United States.
Reprod Toxicol. 2016 Jul;62:87-91. doi: 10.1016/j.reprotox.2016.04.027. Epub 2016 May 2.
Spoon Feed: Ondansetron is safe in hyperemesis gravidarum and does not increase risk for birth defects.

Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.
Clin Infect Dis. 2016 Sep 1;63(5):e61-e111. doi: 10.1093/cid/ciw353. Epub 2016 Jul 14.
Spoon Feed: New IDSA guidelines for HAP and VAP.  HCAP is no more.

Cellulitis: A Review.
JAMA. 2016 Jul 19;316(3):325-37. doi: 10.1001/jama.2016.8825.

Bedtime in Preschool-Aged Children and Risk for Adolescent Obesity.
J Pediatr. 2016 Jul 8. pii: S0022-3476(16)30361-4. doi: 10.1016/j.jpeds.2016.06.005. [Epub ahead of print]

Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women.
Lancet. 2016 Jul 27. pii: S0140-6736(16)30370-1. doi: 10.1016/S0140-6736(16)30370-1. [Epub ahead of print]