EM Literature of Note

DECEMBER 4, 2024

But, the net effect becomes – the ED is a focus for patient safety research. In modern parlance, “diagnostic errors” become “missed opportunities for diagnosis” (MODs), and well-meaning researchers are devising further methods to shine bright lights upon our inadequacies.

Emergency Department 95

Emergency Department Stroke Patient Safety Research 95

Sensible Medicine

AUGUST 12, 2024

Surely you do as well. You can improve your chances by eating well, exercising, avoiding smoking and too much alcohol. 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.

Outcomes 118

Outcomes Research Wellness Hospitals 118

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

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. Your partner asks if you want to administer naloxone as well. Naloxone is a well-established medication used primarily for reversing opioid overdoses. Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in Cali.

Hospitals 96

Hospitals CPR EMS Outcomes 96

Don't Forget the Bubbles

MAY 31, 2023

The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. What outcomes did they look at? Which patients were involved?

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

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 127

Administration Blood Transfusions Outcomes Hospitals 127

The Trauma Pro

SEPTEMBER 20, 2023

Researchers from the US Army performed a retrospective registry study on a sample of military casualties over four years. The primary outcome was mortality, and secondary outcomes included the need for surgery, fluid and blood infusions, and the use of a massive transfusion protocol. AAST 2023 Plenary paper #29.

Military 113

Military Blood Transfusions Administration Outcomes 113

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

ACEP Now

SEPTEMBER 6, 2024

In this case, because outcomes are so dismal already from large-vessel occlusions, there is some benefit to treatment with tenecteplase, 33 percent versus 24 percent advantage for good or excellent functional outcomes. More troubling, however, were the poor patient-oriented outcomes observed in the trial. N Engl J Med.

Research 49

Research Stroke Outcomes Sepsis 49

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. The pathologic vasodilation observed in sepsis is thought to result from failure of the vascular smooth muscle to constrict appropriately, leading to hypotension as well as tissue hypoperfusion (2). Ospina-Tascón GA, Teboul J-L, Hernandez G, et al.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

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] ). His Glasgow Coma Scale (GCS) score is 13 with obvious head trauma as well. Salim Rezaie is a community emergency physician in San Antonio, TX.

EMS 120

EMS Outcomes Hospitals Research 120

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

Sensible Medicine

JULY 29, 2024

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. Importantly, however, there were no differences in health outcome measures, such as BP, BMI, HbA1c or cholesterol level. More than 70% were first-language Spanish speaking.

Outcomes 106

Outcomes Research Sepsis Emergency Department 106

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 127

Ultrasounds Outcomes COPD Hospitals 127

Medagadget

OCTOBER 19, 2023

Researchers at the University of Bath in the United Kingdom have developed a shape-shifting ball that can inflate and deflate in response to someone’s breath. The idea is that the technology makes it easier to maintain focus on the breath, with the goal of better mental health outcomes. The ball works by mirroring someone’s breathing.

Research 80

Research Outcomes Wellness 80

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% 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

Shock 134

Shock Outcomes Resuscitation Stroke 134

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 124

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 124

Don't Forget the Bubbles

JUNE 19, 2024

In adult trauma cases, there has been significant research to help decide which patients require X-ray or CT imaging for possible cervical spine injuries, leading to the development of the National Emergency X-Ray (NEXUS) prediction rule and the Canadian C-Spine Rule (CCR). Why is this study needed?

CPR 124

CPR Research Outcomes Documentation/Coding 124

Medagadget

SEPTEMBER 14, 2023

Researchers at the National University of Singapore have developed a highly sensitive pressure sensor that can provide haptic feedback for surgeons using laparoscopic tools or for use in robotic grippers as part of robotic surgical systems. The introduction of soft and readily integrable eAir sensors, however, could be a game-changer.”

Research 93

Research Operations Outcomes Wellness 93

The Skeptics' Guide to EM

FEBRUARY 15, 2020

Case: A 32-year-old woman with no previous medical history calls you while a passenger on a […] The post SGEM#284: Might as Well Jump, but We would Recommend a Parachute first appeared on The Skeptics Guide to Emergency Medicine. Secondary Outcomes: Health status and subgroup analysis based on type of aircraft or previous parachute use.

Wellness 52

Wellness Outcomes Emergency Department Research 52

EM Literature of Note

NOVEMBER 25, 2024

Baseline characteristics were well-matched, providing a solid foundation for evaluating the intervention’s effect. The null findings for both primary and secondary outcomes should prompt reflection on trial methodology and clinical priorities.

Research 80

Research Outcomes Administration Wellness 80

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., Included traumatic and nontraumatic brain injuries.

CDC 114

CDC Radiology Radiology Outcomes 114

RebelEM

JUNE 19, 2023

The PATCH-trauma researchers sought to address this critique. PMID: 37314244 Clinical Question: In advanced trauma systems, does prehospital administration of TXA increase the rate of survival with a favorable neurologic outcome in patients at risk for trauma-induced coagulopathy? Demographics were well balanced in the two groups.

Outcomes 105

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 105

Sensible Medicine

NOVEMBER 13, 2023

of patients experienced a first primary outcome event in the semaglutide arm vs 8.0% The Kaplan-Meier curves for outcomes began separating early and continued over 3-4 years. There were other positive results as well. Each component of the primary outcome was lower. Patients in the trial were in their low sixties.

Outcomes 95

Outcomes Stroke Wellness Research 95

RebelEM

AUGUST 14, 2023

days 2 most common sites of infection were lung (44.8%) and inta-abdominal (32.1%) Majority of infections were community-acquired (≈84%) Over half the patients were on mechanical ventilation (≈53%) Primary Outcome Results: 28-day mortality rate: Placebo 26.1% (230/882) vs. XBJ 18.8% (165/878); P<0.001 The risk difference was 7.3% (95% CI, 3.4-11.2)

Sepsis 98

Sepsis Outcomes Administration EMS 98

RCEM Learning

JANUARY 23, 2024

But I wanted to continue with my research work, improving the care of patients with blunt chest trauma. This can include randomisation procedures, recruitment and follow-up response rates, what outcome measures patients will prefer, whether patients agree to complete the intervention (in this case the exercise programme) and so on.

Research 72

Research Wellness Outcomes Documentation/Coding 72

Don't Forget the Bubbles

JULY 22, 2024

Randomised controlled trials addressing the benefit of steroids in preschool wheeze have compared different cohorts, used different trial designs and measured different outcomes. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS).

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

The Skeptics' Guide to EM

JUNE 1, 2024

His research focuses on the pre-hospital care of children by EMS. He is the principal investigator for EMSC State Partnership in Washington, DC and is also involved in various multi-center EMS studies with the Pediatric Emergency Care Applied Research Network (PECARN). Well-designed,

Pediatrics 83

Pediatrics EMS Emergency Department Research 83

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 96

Research Outcomes Hospitals Wellness 96

RebelEM

SEPTEMBER 19, 2022

Background: There are only two interventions that have been proven in the medical literature to improved outcomes in cardiac arrest: high-quality CPR and early defibrillation. Over the years, we as a scientific community have worked extensively to find other interventions that improve outcomes. However, human data is sorely lacking.

CPR 52

CPR Outcomes Resuscitation EMS 52

The Skeptics' Guide to EM

DECEMBER 9, 2023

PAIN October 2023 Guest Skeptic: Dr. Caitlin Jones is a Postdoctoral Research Associate at Sydney University’s institute for Musculoskeletal Health. Caitlin Jones is a Postdoctoral Research Associate at Sydney University’s institute for Musculoskeletal Health. What got you interested in that topic?

Research 78

Research Outcomes Wellness 78

Sensible Medicine

AUGUST 21, 2023

On yesterday’s podcast , I talked with Bobby Yeh, an academic cardiologist who made a compelling case for enhancing credibility of observational research. The reasons are multiple, but I will articulate a few: Most epidemiological studies are done from large data sets that are not collected for the purpose of research.

Administration 76

Administration Outcomes Research COPD 76

Taming the SRU

AUGUST 7, 2023

Demel and kreitzer Expanding indications for Thrombolytics Initial tPA window of 0-3 hours number needed to treat (NNT) to achieve a good outcome was 10. hours increased the NNT for a good outcome to 20. Research Grand rounds WITH Drs. The expanded window of 3-4.5

Stroke 92

Stroke Outcomes EKG/ECG Research 92

Sensible Medicine

FEBRUARY 21, 2024

This is the second guest post from Dr. Bienen—a veterinarian whose research focuses on zoonotic disease and associated policies. The study measured a narrow set of outcomes over 22 months. Researchers are just starting to learn how this happens. I learned a lot from this discussion. This review ( Nat.

Research 84

Research Outcomes Wellness 84

Don't Forget the Bubbles

JANUARY 24, 2024

Mortality is high, between 16-43.5% , and neurological outcomes are generally poor amongst survivors. These poor outcomes are related to both the SRSE itself and as a result of the prolonged PICU stay. One study suggests remission in 6 out of 7 patients where it was used, but long-term clinical outcomes remained poor.

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

Sensible Medicine

MARCH 11, 2024

This is where we get into all the terms you see in research papers: p-values, and confidence intervals (typically 95%) – and in the media - margin of error. In the assessment of a clinical trial, we want to know if differences in baseline characteristics may have played a role in the observed outcome.

Outcomes 92

Outcomes Research Stroke COPD 92

Taming the SRU

NOVEMBER 3, 2023

Broad strokes In this prospective, non-randomized study published by Kring et al in January 2022 out of Maine Medical Center, researchers compared mean pain scores at rest and during incentive spirometry before, at 15 minutes after, and then 60 minutes after treatment with a serratus anterior plane block. Ultrasound Med. 41, 2695–2701 (2022).

Fractures 97

Fractures Ultrasounds Outcomes Research 97