July 2023

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This large multi-center retrospective cohort study found no difference in overall risk-adjusted mortality for severely injured trauma patients treated by a surgeon versus non-surgeon trauma team leader (TTL). 

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Do patient outcomes differ when the trauma team leader is a surgeon or non-surgeon? A multicentre cohort study. CJEM. 2023 Jun;25(6):489-497. doi: 10.1007/s43678-023-00516-z. Epub 2023 May 15.

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Emergency intubation in children has similar procedural success rates when directly or indirectly lifting the epiglottis. When indirectly lifting the epiglottis, engagement of the median glossoepiglottic fold is associated with better visualization and success.

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The Importance of Median Glossoepiglottic Fold Engagement on Laryngeal View and Tracheal Intubation Success in Children. Ann Emerg Med. 2023 Jun;81(6):658-666. doi: 10.1016/j.annemergmed.2022.12.027. Epub 2023 Feb 15.

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This ACEP clinical policy covers issues in the evaluating and managing ED patients with suspected appendicitis including clinical prediction rules, comparative imaging modalities, and need for IV contrast in CT imaging.

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Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Appendicitis: Approved by ACEP Board of Directors February 1, 2023. Ann Emerg Med. 2023 Jun;81(6):e115-e152. doi: 10.1016/j.annemergmed.2023.01.015.

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In this very limited study, the microMend* device was found to be comparable to classic repair techniques in terms of wound closure and cosmetic outcome, with high satisfaction among both providers as well as patients, but note the caveats below.

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This retrospective study showed that EM providers are equipped to perform lateral canthotomy and cantholysis (C&C) in cases of orbital compartment syndrome (OCS) with success rates comparable to ophthalmologists.

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Success rates of lateral canthotomy and cantholysis for treatment of orbital compartment syndrome. Am J Emerg Med. 2023 Jun 1;70:140-143. doi: 10.1016/j.ajem.2023.05.037. Epub ahead of print.

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Orbital cellulitis is a high-risk and low-prevalence disease characterized by a painful, red eye, usually with eyelid erythema. Red flags include pain with eye movements, photophobia, diplopia, decreased visual acuity, decreased color vision, and proptosis.

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High risk and low prevalence diseases: Orbital cellulitis. Am J Emerg Med. 2023 Jun;68:1-9. doi: 10.1016/j.ajem.2023.02.024. Epub 2023 Feb 26.

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Video laryngoscopy (VL) was associated with higher rates of first attempt intubation success compared to direct laryngoscopy (DL) for critically ill patients in the ICU and ED. Furthermore, use of VL was associated with better views of the glottis and was especially helpful for clinicians with less intubation experience.

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Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults [published online ahead of print, 2023 Jun 16]. N Engl J Med. 2023;10.1056/NEJMoa2301601. doi:10.1056/NEJMoa2301601

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Analysis of multiple prior RCTs finds direct oral anticoagulants (DOAC) have improved safety and efficacy vs. warfarin in atrial fibrillation (AF) even as renal function decreases to as low as 25 mL/min.

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Direct Oral Anticoagulants Versus Warfarin Across the Spectrum of Kidney Function: Patient-Level Network Meta-Analyses From COMBINE AF. Circulation. 2023 Jun 6;147(23):1748-1757. doi: 10.1161/CIRCULATIONAHA.122.062752. Epub 2023 Apr 12.

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The LUS-ARDS score can make a diagnosis of acute respiratory distress syndrome (ARDS) easier, particularly in patients who can’t have CT scan. The LUS-ARDS score performs similarly to the standard of care (Berlin criteria plus CXR evaluation) in diagnosis of ARDS in ventilated patients.

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There is no association of doxycycline and tooth staining in children under 8 when used at usual dose and duration.

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Antibiotic Exposure and Dental Health: A Systematic Review. Pediatrics. 2023 Jun 2;e2023061350. doi: 10.1542/peds.2023-061350. Online ahead of print.