Contrast Nephropathy Is a Myth
There is increasing literature that supports the notion that radiocontrast administration does not increase the risk of developing acute kidney injury.
Ultrasound or CT for Nephrolithiasis
An ultrasound-first strategy, especially for recurrent kidney stones, was a good way to reduce radiation exposure in patients presenting to the ED with renal colic.
Pan-CT for Trauma – More Evidence Against
This retrospective study echoes REACT-2: pan-scan is low yield. The proportion of patients with clinically significant injury (CSI) involving at least 2 simultaneous body regions - head/neck| chest| abdomen/pelvis was 1 to 3%; 0.6% had CSI simultaneously in all 3 regions.
Isolated Skull Fracture – What to Do
Children with isolated, non-depressed skull fracture did extremely well. Of 6646 children in this systematic review, none died and only one progressed to need neurosurgical intervention.
Canadian CT Head Rule to Reduce CT Use
The Canadian CT Head Rule was 100% sensitive for ruling out clinically important brain injury. It had higher specificity than the New Orleans Criteria, which meant fewer people would need a CT scan by using the Canadian rule.
Coronary CTA vs Functional Stress – Which Is Better?
There was no mortality difference based on which stress test was done, coronary CTA (CCTA) or functional stress testing. But CCTA led to more downstream testing. Either test is fine, but know that tests may have unintended consequences.
Canadian C-spine Rule for Clinical Clearance
The Canadian C-spine rule has high sensitivity for c-spine injury and higher specificity than the NEXUS rule. It allows clinical clearance of more people.
Myth – MRI the Back and They Won’t Return to the ED
Getting an MRI for back pain does not reduce recurrent patient visits within a week. The only time we should get an MRI for back pain in the ED is if there is a clinical concern that the findings may prompt emergent surgery, such as for cauda equina, epidural abscess, or impinging mass (may need radiation), etc.
SCIWORA in the NEXUS Study
Spinal cord injury without radiographic abnormality (SCIWORA) was very rare, 27/34069 (0.08%). Although NEXUS enrolled 3000 patients <18 years, down to age 1, all patients with SCIWORA were adults in this cohort.
News Flash – Asymptomatic Trauma Patients With Negative Scans Do Well
Asymptomatic blunt trauma patients over age 14 with a negative CT abdomen/pelvis did not have delayed missed injuries.