RebelEM

JUNE 29, 2023

Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study. The CT FIRST Trial: Should We Pan-CT After ROSC?, REBEL EM Blog, June 1, 2023. Available at: HERE Branch KHR et al. Resus 2023.

CPR 145

CPR EMS Documentation/Coding Outcomes 145

Sensible Medicine

MAY 28, 2024

The adoption of depression screening is, of course, well-intentioned. 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.

Outcomes 139

Outcomes Military Psychiatric Wellness 139

EM Literature of Note

SEPTEMBER 11, 2023

Well, PRISMS demonstrated unfavorable results. MARISS tried to ascertain predictors of poor outcome in mild stroke, and intravenous thrombolysis was not associated with an effect on the primary outcome. Now, again, we examine thrombolysis in “mild” stroke, in this case, NIHSS ≤3 – and fail.

Stroke 112

Stroke Outcomes Wellness 112

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. 4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. Severe acute traumatic coagulopathy = PT >1.5

Administration 145

Administration Outcomes Resuscitation Radiology 145

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). Blinding procedures were well constructed as to mask group allocation. Prior vaccination was not an exclusion criteria.

Outcomes 145

Outcomes Research Documentation/Coding Wellness 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

Dr. Smith's ECG Blog

JULY 11, 2024

In support of this ECG representing acute proximal LAD OMI — is the clearly abnormal complex in lead aVL ( within the BLUE rectangle ) — which shows a surprisingly wide and deep Q wave ( given tiny size of the QRS in this lead ) — as well as slight-but-real ST elevation of coved morphology with terminal T wave inversion.

EKG/ECG 98

EKG/ECG Outcomes Hospitals Wellness 98

Pediatric EM Morsels

SEPTEMBER 22, 2023

” Children compensate for blood and volume loss very well… until they don’t. Orenstein JB, Klein BL, Gotschall CS, Ochsenschlager DW, Klatzko MD, Eichelberger MR. Age and outcome in pediatric cervical spine injury: 11-year experience. Physical exam findings of occult shock in children can be subtle. J Pediatr Surg.

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

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. Bottom line: Well, this was a new one for me. Several protocols have been developed to try to prevent a retained hemothorax.

Hospitals 133

Hospitals Wellness Outcomes 133

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. What patients, doctors, hospitals and payers want to know is that does the $43 billion spent on screening lead to better outcomes in the average patient. My thinking aligns well with his.

Outcomes 126

Outcomes Research Wellness Hospitals 126

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 95

Hospitals CPR EMS Outcomes 95

The Trauma Pro

JULY 5, 2024

But under-prescribing can create problems as well. Uncontrolled pain is a huge patient dissatisfier, and can lead to unwelcome complications as well (think pneumonia after rib fractures). Make sure all is documented well on the consent or in the EHR.

Documentation/Coding 113

Documentation/Coding Fractures Emergency Department Wellness 113

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

Sensible Medicine

NOVEMBER 20, 2023

The primary outcome was stroke or systemic embolism. Lessons and Questions: This surprise illustrates exactly why we need properly powered Phase 3 trials, which measure hard clinical outcomes. But, ultimately, a new medical intervention has to improve an important outcome as well as or better than standard care.

Stroke 110

Stroke Outcomes Wellness 110

RebelEM

JULY 1, 2024

AVAPS may be useful, but we still need a well conducted RCT to find out if it is (i.e AVAPS: 0.07 P = 0.015 PaCO2 Excretion in 1 st Hour BPAP S/T: 4.75 AVAPS: 10.20 AVAPS: 0.07 P = 0.015 PaCO2 Excretion in 1 st Hour BPAP S/T: 4.75 AVAPS: 10.20 AVAPS: 0.07 P = 0.015 PaCO2 Excretion in 1 st Hour BPAP S/T: 4.75 AVAPS: 10.20

COPD 133

COPD Emergency Department Outcomes EMS 133

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 111

Outcomes Stroke Wellness Research 111

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

The Trauma Pro

SEPTEMBER 20, 2023

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. These low numbers and the nature of this particular registry could inject significant bias as well. AAST 2023 Plenary paper #29.

Military 113

Military Blood Transfusions Administration Outcomes 113

Stop and Think

AUGUST 28, 2024

Trial after trial after trial finds that fixing stable coronary artery disease does not improve outcomes over basic medications and lifestyle changes. The trial found no difference in outcomes. of patients had a primary outcome (death or heart attack). of the patients had a primary outcome (death or heart attack).

Outcomes 117

Outcomes Shock Hospitals Wellness 117

RebelEM

AUGUST 21, 2023

This trial aimed to assess whether targeted therapeutic mild hypercapnia (TTMH) applied during the initial 24 hours of mechanical ventilation in the ICU can enhance neurological outcomes at the 6-month mark, as compared to standard care, which involves targeted normocapnia (TN). Paper: Eastwood G, et al.

Hospitals 98

Hospitals Resuscitation Outcomes CPR 98

Sensible Medicine

NOVEMBER 6, 2023

Today I will tell you about one-year results of the SWISS-APERO trial—which compared outcomes with the two most common types of closure devices. This study report included only 45-day outcomes. They main outcome measure was patency of the left atrial appendage. This is a decidedly bad outcome. Pause there.

Stroke 132

Stroke Outcomes Ultrasounds Wellness 132

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 128

Administration Blood Transfusions Outcomes Hospitals 128

EM Literature of Note

APRIL 11, 2024

Each of these disease states has well-defined pathways for “optimal” therapy and escalation. The most notable feature of this trial is the simple, negative topline result – rollout of this intervention had no reliably measurable effect on patient-oriented outcomes relating to disease progression or acute clinical deterioration.

Outcomes 90

Outcomes Administration Hospitals Wellness 90

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

Don't Forget the Bubbles

DECEMBER 18, 2023

There are many reasons we may continue resuscitation beyond the period when we hope for a good outcome. Maybe that’s still a form of good outcome? The team must know they did their job well and that they’ve given the family precious time with their child, even if the outcome will still be bad. So what do we do?

Resuscitation 131

Resuscitation Outcomes CPR Hospitals 131

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 119

Outcomes Research Sepsis Emergency Department 119

EM Literature of Note

DECEMBER 4, 2024

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. It is also, probably, too unwieldy and labor intensive for routine punitive use targeting individual clinicians.

Emergency Department 92

Emergency Department Stroke Patient Safety Research 92

RebelEM

NOVEMBER 25, 2024

Studies that report the outcome of first-attempt intubation success for both bougie and non-bougie groups. Outcomes: Primary Outcome: First-attempt intubation success The successful placement of the endotracheal tube on the first laryngoscope insertion. Exclusion criteria: Manikin and cadaver studies. hypotension, hypoxemia).

Outcomes 98

Outcomes Emergency Department Operations Hospitals 98

RebelEM

JUNE 19, 2023

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? 1.00 (0.9 – 1.12) Secondary Outcome Mortality 24h 9.7% Demographics were well balanced in the two groups.

Outcomes 105

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 105

Sensible Medicine

OCTOBER 2, 2023

The general concept is how trials measure, report and interpret outcomes. Before any experiment, choices have to be made about which outcome(s) to measure. People will argue about the choices, but a steadfast rule should be that reporting outcomes should be consistent over time. More on the specifics in a moment. The HR was 1.3

Stroke 106

Stroke Outcomes Wellness 106

American Medical Compliance

NOVEMBER 29, 2024

Continuous Glucose Monitoring (CGM) technology is transforming the approach to diabetes care for healthcare providers, including endocrinologists, diabetes educators, and nurses, as well as for the patients they support. However, to maximize its benefits, healthcare providers must be well-versed in the technology.

Outcomes 79

Outcomes Wellness Operations Pediatrics 79

Sensible Medicine

FEBRUARY 27, 2024

Clinical guidelines have potential benefits: improved health outcomes, consistency of care, and reduced uncertainty (for the clinician). In the ideal, clinical guidelines incorporate evidence and expert opinion and enable clinicians to make evidence-based decisions without having to read the primary literature.

Outcomes 116

Outcomes Wellness 116

The Skeptics' Guide to EM

JULY 2, 2023

His Glasgow Coma Scale (GCS) score is 13 with obvious head trauma as well. Most of the times the RCTs we critically appraised did not demonstrate superiority for their primary outcome. Background: We have looked at the use of TXA many times on the SGEM. Reference: PATCH-Trauma Investigators and ANZICS Clinical Trial Group.

EMS 119

EMS Outcomes Hospitals Research 119

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 125

CDC Outcomes Radiology Radiology 125

The Trauma Pro

OCTOBER 25, 2024

Authors from several well-known trauma centers collaborated to re-analyze data from the CLOTT study. Here are the factoids: The original data were derived from a 17-center study conducted from 2018-2020; this study only included 1,387 patients who had pelvic fractures (as well as other injuries).

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

Don't Forget the Bubbles

NOVEMBER 25, 2024

In triage, she is noted to be alert and feeding well. Respiratory viral testing for young febrile infants presenting to emergency care: a planned secondary analysis of the Febrile Infants Diagnostic assessment and Outcome (FIDO) prospective observational cohort study. Was the outcome accurately measured to minimise bias?

Point-of-Care Testing 69

Point-of-Care Testing Outcomes Wellness Emergency Department 69

American Medical Compliance

SEPTEMBER 9, 2024

Skin health is not only a matter of comfort and well-being but also a key indicator of a resident’s overall health status. Recognize and reward teamwork in addressing skin issues. Monitor and Measure Outcomes Regularly monitor the outcomes of skin care interventions.

Teamwork 95

Teamwork Best Practices Outcomes Wellness 95