Medicine/Geriatrics

Stop the Bleeding…of Unnecessary Care – Another Strike Against Delayed Head CT

Imaging, Medicine/Geriatrics, Trauma

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No significant difference in delayed intracranial hemorrhage (dICH) was seen in patients on antithrombotic (AT) medication vs. no AT among patients with repeat CT.

Source
Findings on Repeat Posttraumatic Brain Computed Tomography Scans in Older Patients With Minimal Head Trauma and the Impact of Existing Antithrombotic Use. Ann Emerg Med. 2022 Oct 31;S0196-0644(22)00580-7. doi: 10.1016/j.annemergmed.2022.08.006. Online ahead of print.

Do We Need Delayed Head CT for Anticoagulated TBI Patients?

Imaging, Medicine/Geriatrics, Trauma

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Patients ≥65 years on warfarin with head injury were found to have a significantly higher rate of delayed intracranial hemorrhage (dICH) compared to elderly on direct oral anticoagulants (DOACs) and those not on anticoagulation (AC).

Source
Delayed intracranial hemorrhage after head injury among elderly patients on anticoagulation seen in the emergency department. CJEM. 2022 Oct 15. doi: 10.1007/s43678-022-00392-z. Epub ahead of print.

Old Person + Delirium = Head CT

Imaging, Medicine/Geriatrics, Neurology

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Among patients ≥65 years who presented to the ED with delirium, confusion, or altered mental status, 15.6% had an abnormal head CT. Presence of neurologic deficit was a significant predictor for abnormal CT, but anticoagulation was not.

Source
Head Computed Tomography Findings in Geriatric Emergency Department Patients with Delirium, Altered Mental Status, and Confusion: A Systematic Review. Acad Emerg Med. 2022 Nov 4. doi: 10.1111/acem.14622. Online ahead of print.

Should We Use Steroids in Community Acquired Pneumonia Patients?

Medicine/Geriatrics, Pharmacy/Pharmacology, Pulmonary/Allergy

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Corticosteroid use was associated with a prevention of progression to mechanical ventilation among inpatients with community acquired pneumonia (CAP), but it had no association with the primary outcome of mortality.

Source
Effect of corticosteroids on mortality and clinical cure in community-acquired pneumonia: A systematic review, meta-analysis, and meta-regression of randomized control trials. Chest. 2022 Sep 7;S0012-3692(22)03705-9. doi: 10.1016/j.chest.2022.08.2229. Online ahead of print.

Should We Use Plain Old Doxycycline for Pneumonia?

Infectious Disease, Medicine/Geriatrics, Pharmacy/Pharmacology, Pulmonary/Allergy

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Doxycycline is an accessible and effective option to treat both typical and atypical bacteria that may cause community acquired pneumonia (CAP).

Source
Efficacy of Doxycycline for Mild-to-moderate Community-acquired Pneumonia in Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Clin Infect Dis. 2022 Jul 29;ciac615. doi: 10.1093/cid/ciac615. Online ahead of print.

How to Manage Spinal Stenosis | Spoon-Feed Version

Medicine/Geriatrics, Orthopedics

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Lumbar spinal stenosis affects more than 1 in 10 U.S. citizens and over 100 million patients worldwide. This painful condition is diagnosed clinically with confirmatory imaging. Firstline treatment is activity modification, analgesia, and physical therapy, and careful selection of surgical candidates should be done only if conservative management fails.

Source
Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA. 2022 May 3;327(17):1688-1699. doi: 10.1001/jama.2022.5921.

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