February 2018

Nine percent of patients with negative CT for anterior abdominal stab wound (AASW) subsequently required surgery.  Negative CT for AASW was inadequate to consider patients safe for immediate discharge.

HSV was rare in infants under 60 days, <1%.  However, 9% occurred in weeks 5-6 and 11% in weeks 7-9, which was a much later onset than previously thought.

The AHA released new 2018 guidelines, which are summarized for Emergency Physicians here.  The new guidelines are great, but at 345 pages in length you may want to read the short version.

Sensitivity for UA with any leukocyte esterase, nitrite, or >5 WBCs/hpf was 94% for UTI growing >50,000 colony forming units (CFU).

Total duration of opioid use was the strongest predictor of misuse. Each refill and additional week of opioid use increased the hazard of misuse by 44% and 19.9% respectively. Shorter prescriptions (<2 weeks) of high vs low dosage prescriptions had a lower hazard.

In opioid naïve patients 13-21 years of age, persistent opioid use was found in 4.8% of the post-surgical group vs 0.1% of those in the non-surgical group. Procedures associated with the highest risk of persistent opioid use were cholecystectomy and colectomy. Independent risk factors included older age, female sex, diagnoses of substance use disorder and chronic pain.

EAST concluded spine immobilization in penetrating trauma is unnecessary and associated with an increase in mortality.

Influenza particles are released simply by breathing.  That means, a person does not have to cough or sneeze to spread the flu - just breathing will do it.  This has infection control implications.

This may come as a shock, but when you tell patients no, it negatively impacts patient satisfaction.  But that doesn't make you a bad doctor, regardless of what CMS says.

Don't be falsely reassured if rhinovirus on a PCR viral panel is positive.  The incidence of UTI was unchanged if </= 90 days, and the incidence of invasive bacterial infection (IBI) was no different </= 28 days.  However, it may prove useful for risk stratifying infants for IBI in the 29 to 90-day age group.