The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. Background: We’ve discussed out-of-hospital cardiac arrest (OHCA) at least once or twice on the SGEM (see long list at end of blog). Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in Cali. JAMA Network Open.

Hospitals 103

Hospitals CPR EMS Outcomes 103

ACEP Now

MARCH 11, 2025

1 Further, a Cochrane review found that LMWH is associated with improved outcomes compared with UFH including reduced incidence of major hemorrhage (odds ratio [OR]=0.69; 95 percent CI, 0.50-0.95) no increase in vasopressor use, mechanical ventilation, admission to an intensive care unit, in-hospital mortality). percent to 56.3

Hospitals 52

Hospitals Administration Outcomes Stroke 52

The Trauma Pro

OCTOBER 6, 2023

Although many of these injuries were managed within hours, a growing number were delayed by a few days to improve outcomes. The first is from an international research group that searched the usual databases and initially found 921 records. It is from a group of researchers from our big Boston trauma centers and the Netherlands.

Head Injuries 147

Head Injuries Research Hospitals Resuscitation 147

The Skeptics' Guide to EM

NOVEMBER 9, 2024

Previously, she has been an ED medical director, quality chair, and regional hospital director. Background: In recent years, large language models (LLMs), such as GPT-4 and Claude, have shown remarkable potential in automating and improving various aspects of medical research. eligibility criteria, recruitment, primary outcome, etc.)

Research 58

Research Emergency Department Outcomes Hospitals 58

Sensible Medicine

SEPTEMBER 16, 2024

The New York Times’ piece included this line: Now, a large-scale study from the Feinstein Institutes for Medical Research in Manhasset, N.Y., In the study by Makhnevich and colleagues, the team included adults with dementia who were admitted to 11 diverse hospitals in New York. The primary outcome was death in the hospital.

Outcomes 125

Outcomes Hospitals Research 125

Emergency Medicine Journal

AUGUST 21, 2024

Methods This was a multicentre, parallel-group, open-label, feasibility RCT in seven hospitals in England and Scotland. Feasibility outcomes were recruitment, retention and adherence. Interviews and focus groups with trial participants and clinicians/research staff explored the understanding and acceptability of trial processes.

Fractures 97

Fractures Research Outcomes Hospitals 97

RebelEM

JUNE 1, 2023

Background: Achieving ROSC in out of hospital cardiac arrest (OHCA) is no easy feat but, care doesn’t end with ROSC. Post-ROSC management is nuanced and challenging but helps to ensure good outcomes. In theory, rapid identification of the underlying cause should improve outcomes by allowing clinicians to tailor management.

Outcomes 144

Outcomes Resuscitation Hospitals CPR 144

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. A practical scale. PMID: 4136544.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

The Skeptics' Guide to EM

JANUARY 6, 2024

July 2023 Date: Dec 11, 2023 Guest Skeptic: Dr. Rachel Hatcliffe is a pediatric emergency medicine attending at Children’s National Hospital in Washington, DC. Her research focuses on prehospital care of children with anaphylaxis. […] The post SGEM #425: Are You Ready for This? Veterans Affairs and prison hospitals.

Emergency Department 127

Emergency Department Pediatrics Anaphylaxis Leadership 127

St. Emlyn

JANUARY 27, 2025

St.Emlyn's - Emergency Medicine #FOAMed What is the impact of physician-led interprofessional pre-hospital teams on survival and mortality outcomes for critically ill and injured patients. The post JC: Do physician led prehospital teams improve outcomes? appeared first on St.Emlyn's.

Outcomes 60

Outcomes Hospitals Research Resuscitation 60

Emergency Medicine Journal

OCTOBER 26, 2023

Objective Over 300 000 cases of out-of-hospital cardiac arrests (OHCAs) occur each year in the USA and Europe. Despite decades of investment and research, survival remains disappointingly low. Primary outcome was survival at hospital discharge with a good neurological outcome.

Resuscitation 75

Resuscitation Basic Life Support Hospitals CPR 75

The Trauma Pro

MAY 3, 2024

Various hospital outcomes were tabulated, including hospital charges, mortality, and discharge location. AE and PPP have equivalent outcomes. You can feel comfortable that outcomes will be the same as AE. There is still room for research in this space. What should you do when faced with these patients?

Fractures 113

Fractures Radiology Radiology Documentation/Coding 113

The Skeptics' Guide to EM

JULY 2, 2023

He is the Creator and founder of REBEL EM, a free, critical appraisal blog that tries to cut down knowledge translation gaps of research to bedside clinical practice ( [link] ). Most of the times the RCTs we critically appraised did not demonstrate superiority for their primary outcome. Prehospital Tranexamic Acid for Severe Trauma.

EMS 140

EMS Outcomes Hospitals Research 140

RebelEM

NOVEMBER 30, 2023

PMID: 37597449 Clinical Question : In sepsis patients with CHF, does a restricted volume resuscitation strategy of less than 30mL/kg IV crystalloid initiated within the first three hours of sepsis identification, compared to volume resuscitation with 30 mL/kg IV crystalloid, decrease in-hospital mortality? 2.89, p = 0.01.

Sepsis 118

Sepsis Fluid Resuscitation Resuscitation Administration 118

RebelEM

OCTOBER 30, 2023

This could dilute any beneficial effects seen Lack of blinding may bias results (Although mortality is a solid objective primary outcome, bias may still creep in terms of management) Discussion: Authors were looking for an absolute mortality difference of 7% from baseline mortality of 26% with a 90% power. Cryoprecipitate Group: 25.3%

Administration 125

Administration Blood Transfusions Outcomes Hospitals 125

PulmCCM

JANUARY 15, 2025

In 2020 during the Covid pandemic, researchers at the University of Michigan reported in a letter to the New England Journal of Medicine that in 12% of patients with darker skin, pulse oximeters overestimated their oxygen saturation, reading 92 to 96% when arterial blood gases confirmed the true value to be less than 88%. Nature (news).

Academics 81

Academics Documentation/Coding Administration Research 81

RebelEM

MAY 29, 2023

Most of the research on the use of MB has been in patients with vasoplegia following cardiopulmonary bypass. MB decreases nitric oxide levels by inhibiting inducible nitric oxide synthase (iNOS) and soluble guanylate cyclase (sGC). Through these mechanisms it restores vasoregulation. NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9%

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

Sensible Medicine

AUGUST 12, 2024

Cancer researchers recently quantified the costs of (initial) cancer screening in one year in the US. But first we should set out, as the researchers did, that this is an underestimate of the costs. Most hospitals have dedicated sections for screening. The screening industry is a money-making machine.

Outcomes 133

Outcomes Research Wellness Hospitals 133

Sensible Medicine

JULY 29, 2024

Yet the failure of the hospital readmission penalty policy and sepsis protocols expose the risks of implementing a policy because it sounds good. The background for cash giveaways stem from the association of low income and worse health outcomes. The primary outcome was positive but there were caveats.

Outcomes 118

Outcomes Research Sepsis Emergency Department 118

Don't Forget the Bubbles

DECEMBER 25, 2023

Interpreting Research Outcomes with a Little Bathroom Humour You have learned a method for how to read a research paper , and now you are faced with a bunch of outcomes. There are primary, secondary, composite , and safety outcomes. What are these outcomes? What should you focus on?

Research 83

Research Outcomes Fractures Pediatrics 83

PulmCCM

JANUARY 6, 2025

With financial penalties coming for noncompliance with the new rule, hospital administrators rapidly deployed the alerts to fire on all eligible inpatients. A cluster randomized trial using all-cause mortality as an outcome was always needed to determine whether EMR alerts improve outcomes for suspected severe infection.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

RebelEM

MAY 27, 2024

It is the first research paper to explore the synergistic effects of combining MVM and IV Adenosine in treating PSVT. The primary outcomes are patient-centered and objectively measured, potentially ensuring relevance and reliability. The unblinded nature of the study could influence outcomes due to observer bias.

Outcomes 134

Outcomes Research Operations Hospitals 134

RebelEM

SEPTEMBER 7, 2023

More research is needed to inform preventive treatment strategies for seizures in patients with spontaneous intracerebral hemorrhage (ICH). OUTCOMES Primary: Occurrence of at least one clinical or electrographic seizure recorded on continuous EEG within 72 hours after inclusion. The primary outcome was patient-oriented.

Seizures 123

Seizures Stroke Outcomes Research 123

EMDocs

SEPTEMBER 4, 2024

The emDOCs.net team is very happy to collaborate with PECARN STELAR (Seattle, Dallas/Texas, and Los Angeles) Node and the Emergency Medical Services for Children Innovation and Improvement Center (EIIC) in presenting high-yield pediatric topics that highlight evidence based medicine with solid research.

Pediatrics 97

Pediatrics Outcomes Operations Hospitals 97

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. Unfortunately, there isn’t a lot of research material out there. Not very precise, I know. But what would EAST say? Unfortunately, the data quality was poor, with a significant risk of bias.

Sepsis 186

Sepsis Research Outcomes Hospitals 186

Sensible Medicine

DECEMBER 4, 2023

When I started cardiology, much research focused on improving the care of people who had myocardial infarction (MI). A lot less research goes into post-MI care. In these patients, scientists continue to study ways to improve outcomes. The focus of this column comes in how to measure these outcomes. Times have changed.

Outcomes 102

Outcomes Research Hospitals Stroke 102

Sensible Medicine

JUNE 8, 2024

First, there is a sizable literature on surgical outcomes— the more you do, the better you are. Ironically, for an expert to have better outcomes they have to have a disease modifying therapy AND others can’t know about it! the part-timer question) Lets tackle these, in reverse order First, the issue of part time work.

Research 120

Research Outcomes Hospitals Wellness 120

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 125

Ultrasounds Outcomes COPD Hospitals 125

RebelEM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. SECONDARY OUTCOMES At day 28 , ceftriaxone group had (vs placebo): Lower VAP risk (20% vs 36%); hazard ratio 0.62 4, 8 Paper: Dahyot-Fizelier, C.,

CDC 111

CDC Radiology Radiology Head Injuries 111

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Casey currently splits his time between Broome, a small rural hospital in the remote Kimberley region of Western Australia, and a large tertiary ED in sunny Perth. This same research team from Queensland in Australia have also published a paper describing the learning curve for novices in detection of forearm fractures in kids [6].

Fractures 137

Fractures Ultrasounds Pediatrics Outcomes 137

ACEP Now

MARCH 6, 2024

Every year, the volume of published research continues to outpace capacity to consume. 4 Repeated trials have not shown alteplase to have any signal of better outcomes, nor tenecteplase to have an association with increased adverse events. Gotta catch ‘em all!” How Best to Stop the Bleeding in Trauma?

Research 52

Research Airway Management Stroke Outcomes 52

Sensible Medicine

SEPTEMBER 9, 2024

Most recently, the SGLT2i drugs improved outcomes in patients on these three drugs. Trials select their patients, test the drugs in run-in periods and use research coordinators to help patients navigate complex health systems. The primary endpoint (of hospital readmission for HF or death) occurred in 15.2% A: It does not.

Hospitals 119

Hospitals Outcomes Research 119

ACEP Now

SEPTEMBER 6, 2024

The hypothesis tested in INTERACT-4 is whether antihypertensive treatment might be started even earlier, in the pre-hospital setting, reducing any time-dependent negative effects. 4 Overall, good or excellent outcomes were seen in 79 percent of the reteplase cohort versus 70 percent of those receiving alteplase.

Research 49

Research Stroke Outcomes Sepsis 49

RebelEM

OCTOBER 5, 2023

Secondary Outcome By day 90, mortality was 9.3% Strengths: The investigators framed a research question centered on patient outcomes, ensuring the study’s relevance and practicality. Control: Normal Saline via continuous infusion according to the same regimen used in the hydrocortisone group. to −0.8).

Research 94

Research Outcomes Administration Shock 94

Mind The Bleep

JANUARY 18, 2024

Introduction Starting my research journey as a medical student has been an incredible and transformative experience. In this article, I wholeheartedly share my personal journey, and the invaluable lessons I’ve learned along the way, and offer friendly tips to fellow medical students who aspire to delve into the world of research.

Research 52

Research Administration Hospitals Outcomes 52

Sensible Medicine

NOVEMBER 30, 2023

Typically, we place the burden on manufacturers to show that their products improve health outcomes prior to sale. Why can’t GRAIL—with its multibillion dollar evaluation—pay for their own research? We don’t know all the side effects and harms of GRAIL, and downstream interventions.

Research 145

Research Radiology Radiology Administration 145

The Trauma Pro

OCTOBER 4, 2024

Clinical outcomes assessed at 60 days included an unplanned return to the emergency department (ED), re-admission, complications, and development of new bleeding confirmed by surgery, ultrasound, or computed tomography (CT) at 60 days post-injury. Adherence to guidelines was assessed by a follow-up phone call two months after injury.

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113