Pediatric EM Morsels

JULY 28, 2023

Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. 2022; 23( 7): 835- 856. Is your patient hyperglycemic, acidotic, with ketonuria? Then we’ve likely got DKA.

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

RebelEM

MAY 25, 2023

vs 3U) but no difference in mortality (Study not powered for this outcome) Clinical Take Home Point: The use of vasopressors is controversial and requires a nuanced approach SUMMARY OF MINIMIZING IATROGENIC INJURY RESTORE PERFUSION VOLUME REPLACEMENT Blood Products >>> Crystalloids Holcomb JB et al. NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

RebelEM

DECEMBER 23, 2024

There has been ongoing study about the clinical significance of these effects, as well as whether and for whom LR might provide meaningfully better clinical outcomes ( Myburgh 2013 , Self 2018 , Semler 2018 , Self 2020 ). The enrollment was multicenter, large, and adequately powered for clinically meaningful changes in outcome.

Fluid Resuscitation 123

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 123

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Health Sci Rep 2022. Three outcomes were evaluated, with none being deemed the primary outcome. Health Sci Rep 2022. Background: Sepsis remains one of the leading causes of morbidity and mortality.

Sepsis 131

Sepsis Hospitals Administration Outcomes 131

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7%

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145

RebelEM

SEPTEMBER 7, 2023

About 30% of patients experience early seizures within seven days following the onset of a stroke ( Peter-Derex 2022 ). Lancet Neurology 2022; 21:781-91. OUTCOMES Primary: Occurrence of at least one clinical or electrographic seizure recorded on continuous EEG within 72 hours after inclusion. PMID: 35963261. OR 0.07, 95% CI 0.01-0.38,

Seizures 125

Seizures Stroke Outcomes Research 125

Pediatric EM Morsels

AUGUST 9, 2024

If not treated early, then increased risk of poor outcomes and death. Early Congenital Syphilis Present before 2 years of age [ Hussain, 2023 ; Foles, 2024; Fang, 2022; Morrisroe, 2021 ] Only ~33% of newborns present with symptoms at birth and can be subtle. 2022 Dec 27;14(12):e33009. Most will develop signs by 3 months of age.

Hyperthermia / Hypothermia 152

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 152

Don't Forget the Bubbles

MAY 31, 2023

2023 May 17:archdischild-2022-325280. doi: 10.1136/archdischild-2022-325280. What outcomes did they look at? Was the outcome accurately measured to minimise bias? The inability to test for SARS-CoV-2 antibodies may have led to an underestimation of the impact of the virus on the reported outcomes. Arch Dis Child.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

The Trauma Pro

JANUARY 5, 2024

The group at the Medical College of Wisconsin performed a trial of thoracic cavity irrigation and compared the outcomes with patients who did not undergo irrigation. The only prior study I could find was published in 2022 by a group at the University of Nevada at Las Vegas. 2022 Nov;279:62-71. EAST 2024, Podium paper #17.

Hospitals 133

Hospitals Wellness Outcomes 133

Pediatric EM Morsels

AUGUST 11, 2023

Infections there become complicated very quickly and the outcomes can be very poor. 2022 Sep;68(9):661-663. Inpatient Vs Outpatient Therapy No standard approach… but… here is what I say: “ Always Fear Infections in the Hands, Feet, or Face.” ” Those areas have very important and delicate structures.

Burns 130

Burns Pediatrics EMS Outcomes 130

RebelEM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. Outcomes: Primary Outcome: Reduction of dyspnea measured on a verbal dyspnea scale (VDS) from 0 to 10 recorded at enrollment, then at 2, 4, and 5 hours after arrival.

Ultrasounds 126

Ultrasounds Outcomes COPD Hospitals 126

Emergency Medicine Journal

AUGUST 21, 2024

Feasibility outcomes were recruitment, retention and adherence. Clinical end points (pulmonary complications, pain and frailty-specific outcomes) and patient questionnaires were collected to determine feasibility of data collection and inform health economic scoping. Pain and some frailty-specific outcomes were not feasible to collect.

Fractures 97

Fractures Research Outcomes Hospitals 97

RebelEM

SEPTEMBER 21, 2023

Up to 80% of patients will have at least one troponin sent ( Gabrielli 2022 ). The available literature shows that SVT is not associated with ACO, Type I MI or serious outcomes either in the short term or after prolonged follow up ( Gabrielli 2022 ). Additionally, they found that up to 30% of the troponins sent are positive.

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

The Trauma Pro

OCTOBER 3, 2023

There was no difference in pain, return to work, functional outcome, or instrumentation failure. Int J Burns Trauma 12(4):168-174, 2022. It looked at loss of deformity correction, return to work, functional improvement, instrumentation failure rate, pseudoarthrosis, and postop complications. A total of 76 studies were included.

Fractures 203

Fractures Dislocations Operations Burns 203

PulmCCM

OCTOBER 16, 2024

This is a remarkable example of the differences between societies, which might influence the processes of clinical trials and their outcomes. RIPC has not been shown to improve cardiovascular outcomes more generally after cardiac surgery. 2022 Mar 1;134(3):592-605. Long YQ, Feng XM, Shan XS, Chen QC, Xia Z, Ji FH, Liu H, Peng K.

Outcomes 52

Outcomes Operations Research Hospitals 52

PulmCCM

DECEMBER 11, 2023

Sepsis, infectious disease Managing septic shock with a restrictive-fluids approach (preferentially using vasopressors after a single liter crystalloid bolus) led to similar outcomes as the usual practice of bolusing large volumes of fluids first. Vitamin C did not improve outcomes among patients hospitalized with Covid-19.

Sepsis 94

Sepsis Stroke Shock Infectious Diseases 94

Emergency Medicine Journal

JUNE 22, 2023

The primary outcome was intubation or non-invasive ventilation, death or intensive care unit admission at 30 days. Results Of the 446 084 patients, 15 397 (3.45%, 95% CI 34% to 35.1%) experienced the primary outcome. Clinical decision-making for inpatient admission achieved a sensitivity of 0.77 (95% CI 0.76

Outcomes 98

Outcomes 98

PulmCCM

SEPTEMBER 21, 2023

A 2015 meta-analysis of 13 randomized trials enrolling >12,000 patients suggested that active blood pressure management after ischemic strokes had little effect on eventual outcomes, and that delaying blood pressure control for three days did not lead to worse outcomes (death or disability).

Stroke 105

Stroke Outcomes 105

The Trauma Pro

AUGUST 25, 2023

They tried to perform a systematic review and meta-analysis of studies that compared outcomes in splenectomy vs. angioembolization patients. Injury 53:3569-3574, 2022. If a distal embolization were performed, I would eyeball the amount of devascularized spleen and give the vaccines if it looked like more than half was dark.

Sepsis 187

Sepsis Research Outcomes Hospitals 187

The Skeptics' Guide to EM

DECEMBER 21, 2024

The inspiration for the SGEM Xtra episode is the BMJ 2022 holiday article called "The 12 Days of Christmas, the Statistician Gave to Me,". Outcomes: Clearly defined primary and secondary endpoints. Its fun to mix it up and not do a structured critical appraisal of a recent publication and have a more philosophical chat.

Outcomes 97

Outcomes Research Ultrasounds 97

RebelEM

MAY 27, 2024

What they did: Prospective randomized controlled trial, unblinded, multicenter study Conducted from January 2017 to December 2022 Patients with confirmed PSVT were randomly assigned to receive MVM, IV Adenosine, or combined therapy. The unblinded nature of the study could influence outcomes due to observer bias.

Outcomes 135

Outcomes Research Hospitals Operations 135

Intensive Blog

MARCH 13, 2024

This showed a similar rate of survival to discharge (27%), of whom approximately 50% had a favourable neurological outcome on discharge (CPC 1 or 2). Multiple meta-analyses 9,10 found that ECPR, when compared to conventional CPR (CCPR), was associated with improved 30-day mortality and neurological outcomes. More recently ….

CPR 130

CPR Resuscitation Outcomes Hospitals 130

Sensible Medicine

MAY 28, 2024

In October 2022 , the USPSTF recommended childhood anxiety screening starting at eight years old. A 2008 Cochrane review found adult depression screening does not improve outcomes. The last two trials convincingly demonstrate that when patients with postpartum depression have better access to mental health services, outcomes improve.

Military 129

Military Outcomes Psychiatric Wellness 129

RebelEM

MAY 29, 2023

What They Did: Single-center, parallel, double blind, randomized controlled trial performed in a medical-surgical ICU (Mexico) Both groups received: Adjunctive vasopressin initiated at a dose of 0.03 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Tessa Davis covered the FORCE trial on SGEM #372 which looked at buckle fractures and compared immobilization in a cast or splint vs. a soft bandage and they found no difference in pain scores or functional outcomes. Reference: Snelling et al. Ultrasonography or radiography for suspected pediatric distal forearm fractures.

Fractures 122

Fractures Ultrasounds Pediatrics Outcomes 122

RebelEM

SEPTEMBER 2, 2024

Published 2022 Sep 10. Device-Oriented Outcomes : While suction rate improvements were significant, the clinical relevance of these findings remains uncertain. While the suction rates observed are impressive, it is unclear whether using the DuCanto catheter would lead to improved clinical outcomes. Published 2022 Sep 10.

Airway Management 115

Airway Management Outcomes EMS Research 115

Emergency Medicine Journal

APRIL 22, 2024

Methods In this multicentre, parallel-group, randomised controlled superiority trial conducted between January and August 2022, adults who smoked daily and attended one of six UK EDs were randomised to intervention (brief advice, e-cigarette starter kit and referral to stop smoking services) or control (written information on stop smoking services).

Emergency Department 97

Emergency Department Outcomes 97

Taming the SRU

MARCH 27, 2024

The parent trial was conducted from October 2020 to July 2022 in the capital region of Denmark. The primary outcome was cumulative norepinephrine use during the first 48 hours of admission. That said, outcomes for these patients are generally poor and the use of steroids as a one-time dose likely has little risk. Hill, J.

Resuscitation 97

Resuscitation Outcomes CPR Hospitals 97

PulmCCM

OCTOBER 7, 2024

What’s the evidence for this practice, in terms of efficacy, outcomes, and safety? Randomized Trials of Midodrine in the ICU At least four randomized trials testing midodrine in the ICU were published between 2020 and 2022, as described in a narrative review by Costa-Pinto et al. All but one were retrospective. Read more

Shock 98

Shock Outcomes 98

EMDocs

SEPTEMBER 8, 2024

Delaying treatment of elevated BP in patients may lead to worse outcomes, and an optimal IV antihypertensive medication will reach the BP goal rapidly while avoiding hypotension and causing end organ injury. Authors extracted proportions dichotomous outcomes (in-hospital mortality) and calculated risk ratios. clevidipine).

Stroke 81

Stroke Outcomes Hospitals 81

ACEP Now

JUNE 21, 2023

2,3 In the 2021-2022 academic year, categorical (non-combined) EM residency lengths included 221 (80 percent) PGY 1-3 and 55 (20 percent) PGY 1-4 programs. The lack of differences in the observed outcomes do not suggest one EM training length is superior. Accessed 2022-03-26. 1 Curricula with non-EM internships (i.e.,

EMS 114

EMS Academics Telemedicine Operations 114

RebelEM

JULY 27, 2023

In this group of patients, the use of alteplase poses a fine line of potential benefit (functional outcomes) vs potential harm (symptomatic intracranial hemorrhage). Many patients, however, will have minor strokes (defined as an NIHSS score ≤5). Alteplase: 91.4% Risk Diff: 2.3%; 95% CI -1.5 Alteplase: 0.9% Any Bleeding Events: DAPT: 1.6%

Stroke 98

Stroke Outcomes EMS Hospitals 98

Broome Docs

OCTOBER 6, 2024

Can acutely ill patients predict their outcomes? doi: 10.1136/emermed-2022-213000. Mols EM, Haak H, Holland M, Schouten B, Ibsen S, Merten H, Christensen EF, Nanayakkara PWB, Nickel CH, Weichert I, Kellett J, Subbe CP, Kremers MNT; Safer@Home Research Consortium. A scoping review. Emerg Med J. 2024 May 28;41(6):342-349.

Emergency Department 112

Emergency Department EMS Research Outcomes 112

PulmCCM

JANUARY 15, 2025

In 2022, a class-action lawsuit was filed against Apple in New York alleging that the pulse oximeter on Apple Watches was inaccurate in dark-toned patients. Clinical Outcomes Associated With Overestimation of Oxygen Saturation by Pulse Oximetry in Patients Hospitalized With COVID-19. ABC News December 29 2022 Fawzy et al.

Documentation/Coding 81

Documentation/Coding Academics Administration Research 81

EMDocs

FEBRUARY 20, 2024

2022 Sep 15;387(11):989-1000. Comparison of clinical outcomes between aggressive and non-aggressive intravenous hydration for acute pancreatitis: a systematic review and meta-analysis. Question: What are the outcomes between aggressive and non-aggressive intravenous hydration in severe and non-severe AP? N Engl J Med.

Fluid Resuscitation 83

Fluid Resuscitation Resuscitation Outcomes Hospitals 83

EMDocs

SEPTEMBER 3, 2024

Secondary: % change from baseline in anti-factor Xa activity during the first 2 hours from randomization Safety (assessed at 30 days): thrombotic events (ischemic stroke, VTE, myocardial infarction), mortality Results: 452 patients analyzed for the primary outcome. 530 patients analyzed for safety outcome. Blinded outcome assessors.

Stroke 76

Stroke Outcomes Hospitals 76

Emergency Medicine Journal

JANUARY 22, 2024

Methods This was an open-label randomised control trial conducted in a tertiary care teaching hospital in India from 11 November 2021 to 30 November 2022. The primary outcome was symptom resolution at 6 hours and 12 hours. Consenting participants were randomised to high-dose GTN or conventional low-dose GTN.

Outcomes 75

Outcomes Hospitals 75