When to Pan-Scan vs. Selectively CT Elderly Patients
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Based on key history and physical examination findings, the Eastern Association for the Surgery of Trauma (EAST) developed an algorithm for the evaluation of blunt trauma patients ≥65 years.
Source
Scanning the aged to minimize missed injury: An EAST multicenter study. J Trauma Acute Care Surg. 2024 May 27. doi: 10.1097/TA.0000000000004390. Online ahead of print. PMID: 38797882
Keith Wrenn Always Said, “Presyncope IS Syncope.” He Was Right
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This systematic review found that approximately 4%-27% of patients presenting to the ED with presyncope experienced serious outcomes within a 30-day period.
Source
Serious outcomes among emergency department patients with presyncope: A systematic review. Acad Emerg Med. 2024 Jun 9. doi: 10.1111/acem.14943. Online ahead of print. PMID: 38853536
UA Parameters and UTI – One Size Fits All?
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In a multi-hospital retrospective review of over 3,000 patient encounters, common urinalysis (UA) parameters had poor positive predictive value (PPV) in diagnosing urinary tract infection (UTI). Absence of certain parameters (i.e. pyuria and leukocyte esterase) had a high negative predictive value (NPV) for ruling out UTI, but were less reliable in older female patients.
Source
Performance of Urinalysis Parameters in Predicting Urinary Tract Infection: Does One Size Fit all? Clin Infect Dis. 2024 Apr 26:ciae230. doi: 10.1093/cid/ciae230. Epub ahead of print. PMID: 38666412.
Mesenteric Ischemia – What You Need to Know
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This is a concise review on the diagnosis and management of mesenteric ischemia.
Source
Just the facts: Evaluation and management of mesenteric ischemia. CJEM. 2024 May;26(5):316-318. doi: 10.1007/s43678-024-00696-2. Epub 2024 May 7. PMID: 38714638.
Should We Diagnose and Start Hypertension Treatment in the Emergency Department?
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This was an analysis of the 2016-2019 National Hospital Ambulatory Medical Care Survey (NHAMCS) of patients presenting to the ED with asymptomatic hypertension. ED physicians infrequently diagnosed hypertension in this cohort and rarely initiated outpatient antihypertensive prescriptions.
Source
Missed Opportunities to Diagnose and Treat Asymptomatic Hypertension in Emergency Departments in the United States, 2016-2019. The Journal of emergency medicine vol. 66,5 (2024): e562-e570.
Golden Years, Hidden Dangers – Blunt Head Trauma in the Elderly
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This study demonstrated that patients 65 years and older with blunt head trauma are at high risk of significant traumatic brain injuries and poor outcomes even with low-risk mechanisms of injury such as ground level falls and no other high-risk criteria besides advanced age. These findings suggest routine head CT imaging may be helpful for elderly patients with head trauma as clinical assessment may not identify patients with significant pathology.
Source
Blunt Head Injury in the Elderly: Analysis of the NEXUS II Injury Cohort. Ann Emerg Med. 2024 Feb 9:S0196-0644(24)00003-9. doi: 10.1016/j.annemergmed.2024.01.003. Online ahead of print.
CAP Coverage – Beta Lactam Only?
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In patients hospitalized with non-severe community-acquired pneumonia (CAP), beta-lactam (BL) only antibiotic regimens have been shown to have increased mortality as compared to other first-line regimens.
Source
Comparative Effectiveness of First-Line and Alternative Antibiotic Regimens in Hospitalized Patients With Nonsevere Community-Acquired Pneumonia: A Multicenter Retrospective Cohort Study. Chest. 2024 Jan;165(1):68-78. doi: 10.1016/j.chest.2023.08.008. Epub 2023 Aug 11.
Grandma MIGHT Have Hit Her Head…CT or Not?
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Overall rates of intracranial hemorrhage (ICH) in patients >65 years of age with either definite or uncertain head trauma were found to be 11.4% and 1.7%, respectively, leading these authors to recommend head CT imaging on all geriatric patients presenting with possible head trauma.
New Meta-Analysis – Steroids Lower CAP Mortality
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This meta-analysis found a reduction in all-cause mortality in patients hospitalized with severe CAP who received adjunctive corticosteroid therapy.
Source
Efficacy and Safety of Corticosteroid Therapy for Community-Acquired Pneumonia: A Meta-Analysis and Meta-Regression of Randomized, Controlled Trials. Clin Infect Dis. 2023 Dec 15;77(12):1704-1713. doi: 10.1093/cid/ciad496.
The Real Risks of Boarding in the Emergency Department
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In this large, multicenter prospective cohort study in France, researchers found that patients ≥75 years who were admitted overnight boarding in the ED had higher rates of in-hospital mortality, length of stay, and adverse events.
Source
Overnight Stay in the Emergency Department and Mortality in Older Patients. JAMA Intern Med. 2023 Dec 1;183(12):1378-1385. doi: 10.1001/jamainternmed.2023.5961.