Sensible Medicine

JULY 30, 2024

In this context, the Canary Prostate Active Surveillance Study ( PASS ) sought to understand the long-term outcomes of active surveillance. Question What are the long-term outcomes for patients with favorable risk prostate cancer managed with protocol-directed active surveillance?

Outcomes 91

Outcomes Research 91

Pediatric EM Morsels

JULY 26, 2024

Higher titers in both CSF and serum were associated with poor outcomes. Earlier diagnosis leads to better outcomes. Younger Age at Onset Is Associated With Worse Long-term Behavioral Outcomes in Anti-NMDA Receptor Encephalitis. HSV serum and CSF PCR HSV is one of the most common etiologies of encephalitis and is devastating.

Psychiatric 269

Psychiatric Seizures Outcomes Pediatrics 269

The Trauma Pro

JANUARY 2, 2024

EAST sponsored a prospective, multicenter study to identify factors influencing neurologic outcomes after spinal cord injury. It would be interesting to see if patients who had very consistent MAP therapy, say greater than 90% or 95% of the time, had any difference in outcomes. Could a single low MAP cause damage?

Outcomes 264

Outcomes Hospitals 264

Pediatric EM Morsels

APRIL 19, 2024

No formal follow up was scheduled Outcomes were: effectiveness, parental satisfaction, and economic benefits The majority of children wore their braces as directed (94%)There was no re-fractureAll parents were happy with the treatment (100%) and felt comfortable removing the brace (100%). West, 2005. Plint, 2006.

Fractures 286

Fractures Pediatrics Best Practices Outcomes 286

The Trauma Pro

JUNE 21, 2024

This situation was first documented in a paper published in the 1960s, which noted that VIP patients have worse outcomes. The VIP syndrome occurs in healthcare when a celebrity or other well-connected “important” person receives a level of care that the average person does not. Who is a VIP? It may be a celebrity. A family member.

Documentation/Coding 290

Documentation/Coding Outcomes Hospitals Wellness 290

The Trauma Pro

DECEMBER 17, 2024

Here are the factoids from their study: Motor vehicle crash was the most common etiology for this lesion, which makes sense due to the energy needed to shear the tissues The most common locations were thigh, hip, and flank The incidence of pre-existing conditions that might influence outcome (diabetes, obesity, smoking history, use of anticoagulants) (..)

Outcomes 191

Outcomes 191

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

Dr. Smith's ECG Blog

JULY 11, 2024

In general, family medicine physicians may not have the same amount of exposure to EKGs as an emergency medicine specialist or a cardiologist, but they shouldn’t have to rely on the traditional diagnostic computer algorithm.

EKG/ECG 98

EKG/ECG Outcomes Hospitals Wellness 98

The Trauma Pro

AUGUST 19, 2024

I’ve seen the clinical problems and poor outcomes that can arise from ignoring it many times over the years. Here’s another one. You’ve ordered a CT or a conventional x-ray image. The result comes back in your EMR. You take a quick glance at the summary at the bottom of the report. No abnormal findings are listed.

Outcomes 193

Outcomes 193

RebelEM

JUNE 1, 2023

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. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study.

Outcomes 145

Outcomes Resuscitation Hospitals CPR 145

Don't Forget the Bubbles

NOVEMBER 11, 2024

One-liner… Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in paediatric populations, and fever is associated with worse outcomes. The aim of TTM is to control the body and brain’s temperature, thus reducing secondary brain injury and improving the neurological outcome.

Hyperthermia / Hypothermia 116

Hyperthermia / Hypothermia Outcomes Pediatrics Resuscitation 116

Mount Sinai EM

AUGUST 7, 2024

Initially, data suggested that the use of ultrasound during arrest increased pauses between compressions which worsens outcomes. Ultrasound during cardiac arrest has quickly become standard. To decrease time between compressions, many protocols were proposed (see here ).

Ultrasounds 235

Ultrasounds CPR Documentation/Coding COPD 235

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Three outcomes were evaluated, with none being deemed the primary outcome. Background: Sepsis remains one of the leading causes of morbidity and mortality. to 0.97; p = 0.02 to 2.07; p = 0.91 to 12.33; p = 0.26

Sepsis 132

Sepsis Hospitals Administration Outcomes 132

Mount Sinai EM

AUGUST 20, 2023

Activate ECMO team early, cardiac arrest due to LAST might be prolonged (especially with bupivacaine) and there’s several case reports with good outcomes after ECMO. Start intralipid emulsion 20% bolus 1.5 mg/kg and infusion, repeat bolus until ROSC (max total dose of Intralipid solution 12 ml/kg).

Seizures 238

Seizures Shock Outcomes 238

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

SEPTEMBER 2, 2024

Next point: look at the number of primary outcome events. Third point: the authors knew that people would be interested in other outcomes besides the composite of CVD, MI and stroke. The problem with this is that one specific outcome will surely have fewer events than 3 combined. That is a lot of events.

Stroke 118

Stroke Outcomes 118

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 129

Ultrasounds Outcomes COPD Hospitals 129

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 145

Administration Outcomes Resuscitation Radiology 145

The Bottom Line

JUNE 19, 2023

In adult patients with major trauma, who are at risk for trauma-induced coagulopathy does early administration of 1g of tranexamic acid (TXA) followed by an infusion of 1g over 8 hours, compared with placebo, increase survival with a favourable functional outcome at 6 months?

Administration 145

Administration Outcomes Shock 145

RebelEM

MAY 27, 2024

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. Employing P-values to compare demographics between groups could mislead interpretations of the data’s relevance to the primary outcomes.

Outcomes 137

Outcomes Research Hospitals Operations 137

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 136

Stroke Outcomes Hospitals Administration 136

The Trauma Pro

DECEMBER 22, 2023

The reality is that no one will ever be able to design a study that definitively evaluates the very soft outcomes that result from using this technique. It can help direct the surgical exploration if imaging was unnecessary or contraindicated. So yes, this is dogma.

Operations 264

Operations Outcomes 264

The Skeptics' Guide to EM

NOVEMBER 30, 2024

With a survival rate to discharge often below 10% globally, rapid, effective interventions are needed to improve patient outcomes. Multiple studies have demonstrated how the administration of epinephrine can improve short-term outcomes, such as return of spontaneous circulation (ROSC).

Administration 86

Administration CPR Airway Management Outcomes 86

Emergency Medicine Cases

MAY 28, 2024

Paying attention to the time-sensitive details of ED management of SAH patients can have a significant impact on their outcome. What is the evidence for oral nimodipine in improving outcomes in patients with subarachnoid hemorrhage and how does it work? Mortality in SAH patients can be up to 30% even without neurological deficit.

Outcomes 124

Outcomes EMS 124

St. Emlyn

JULY 11, 2024

These guidelines advocate a trauma-informed, multidisciplinary approach to improve outcomes for patients who have experienced NFS. St.Emlyn's - Emergency Medicine #FOAMed The Faculty of Forensic & Legal Medicine's guidelines for managing non-fatal strangulation (NFS).

Forensics 128

Forensics Outcomes 128

Sensible Medicine

SEPTEMBER 16, 2024

The primary outcome was death in the hospital. Other outcomes included respiratory complications (pneumonia), intubation and hospital length of stay (LOS). Results They found no significant difference in the primary outcome of death. The components of the primary outcome went in different directions.

Outcomes 121

Outcomes Hospitals Research 121

Science Based Medicine

JUNE 17, 2024

A few months ago, I wrote about how antivaxxers misrepresent vaccine safety studies to portray vaccines as dangerous, using a large study of outcomes in adults as an example. They're doing it again, but this time it's a large study of COVID-19 vaccines in children.

Outcomes 130

Outcomes 130

St. Emlyn

FEBRUARY 27, 2024

How we can improve patient outcomes. St.Emlyn's - Emergency Medicine #FOAMed A review of Acute on Chronic Liver Disease (ACLD / decompensated liver disease) in the ED. FOAMed @stemlyns The post Decompensated. Liver disease in the ED. St Emlyn’s appeared first on St.Emlyn's.

Outcomes 125

Outcomes Resuscitation 125

RebelEM

SEPTEMBER 14, 2023

to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% Control: 53.4% D ECLS: 18.2% Control 8.7% Control 38.0% Control: 49.0% RR 0.98; 95% CI 0.80 to 1.19; p = 0.81 vs 13.9% (RR 0.58; 95% CI 0.33 Control: 9.6% Control 3.8%

Shock 136

Shock Outcomes Resuscitation Stroke 136

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). That sounds reasonable, so what has changed? 0.41), p < 0.001.

Pediatrics 183

Pediatrics Emergency Department Outcomes Sepsis 183

St. Emlyn

NOVEMBER 19, 2024

This review explores outcomes in drainage efficacy, complication rates, and patient comfort, showing that small-bore thoracostomy may be a reliable alternative for non-emergent cases. However, for severe trauma or urgent settings, large-bore remains the go-to option.

Outcomes 104

Outcomes 104

RebelEM

SEPTEMBER 7, 2023

OUTCOMES Primary: Occurrence of at least one clinical or electrographic seizure recorded on continuous EEG within 72 hours after inclusion. 0.38, p=0.0021) No statistically significant results were reported in the other clinical outcomes studied. The primary outcome was patient-oriented. OR 0.07, 95% CI 0.01-0.38,

Seizures 133

Seizures Stroke Outcomes Research 133

Sensible Medicine

MAY 28, 2024

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. Screening had no impact on depression, anxiety, or a host of other mental health outcomes.

Military 139

Military Outcomes Psychiatric Wellness 139

RebelEM

JUNE 22, 2023

Outcomes: Primary: The development of long-COVID up to 300 days after enrollment. This secondary outcome became the primary outcome (see discussion for more detail). As a secondary outcome, the authors wanted to investigate the development of long COVID. Prior vaccination was not an exclusion criteria.

Outcomes 145

Outcomes Research Documentation/Coding Wellness 145

RebelEM

FEBRUARY 15, 2024

not a patient oriented outcome) Single country study which may limit generalizability Excluded pregnancy where risk of emesis is increased due to gravid uterus Alcohol was the implicated in the overwhelming majority of patients.

Poisoning 141

Poisoning Airway Management Seizures Shock 141

RebelEM

MAY 29, 2023

Without larger studies and a patient centered outcome, the addition of methylene blue within 24 hours of septic shock should still not be part of a general approach but rather an adjunct in specific circumstances (i.e. 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%

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

Sensible Medicine

AUGUST 3, 2024

What was the outcome? The outcome was not illness. ” To reiterate, the outcome was clicking the right boxes in an online survey. This study's surrogate treatment and outcome are so many steps away from the causal chain we cared about. The control group was explicitly instructed not to wear masks. What did we learn?

Documentation/Coding 135

Documentation/Coding Outcomes Research 135