Top Recent Articles: One ED Professor's View
By: Bruce Jancin, Hospitalist News Digital Network 11/18/12
http://www.ehospitalistnews.com/single-view/top-recent-articles-one-ed-professor-s-view/4e9f568609a63ae8ce65250e6e702d7b.html
• Results of the first-ever head-to-head comparison of MRI vs. CT for diagnosis of
occult hip fractures in the elderly
CONCLUSION: Although 64-slice CT detected the majority of occult fractures, it missed four (2%) significant fractures detected by MRI. CT scan is helpful in the diagnosis of occult hip fracture, but one should not completely exclude the diagnosis based on a negative 64-slice CT scan in a patient with persistent, localized hip pain who cannot bear weight.
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• ALARA: This is an acronym for ‘As Low as Reasonably Achievable’
radiation exposure.
CONCLUSION: Low-dose CT was noninferior to standard-dose CT with respect to negative appendectomy rates in young adults with suspected appendicitis.
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• Pulmonary embolism overdiagnosis
CONCLUSION: The introduction of CTPA was associated with changes consistent with overdiagnosis: rising incidence, minimal change in mortality, and lower case-fatality. Better technology allows us to diagnose more emboli, but to minimize harms of overdiagnosis we must learn which ones matter.
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• Hyperbaric oxygen therapy for carbon monoxide poisoning
CONCLUSION: In patients with transient loss of consciousness, there was no evidence of superiority of HBO over NBO. In comatose patients, two HBO sessions were associated with worse outcomes than one HBO session.
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• Nonsurgical hemorrhage control
CONCLUSIONS: The use of TXA with blood component-based resuscitation following combat injury results in improved measures of coagulopathy and survival, a benefit that is most prominent in patients requiring massive transfusion. Treatment with TXA should be implemented into clinical practice as part of a resuscitation strategy following severe wartime injury and hemorrhage.
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• ‘ARDS, acronyms, and the Pinocchio effect’