Síguenos en Twitter     Síguenos en Facebook     Síguenos en YouTube     Siguenos en Linkedin     Correo Salutsantjoan     Gmail     Dropbox     Instagram     Google Drive     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon


My photo
FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, March 13, 2018

BNP in the ED

First10EM - By Justin Morgenstern - March 13, 2018
"In the most recent episode of Emergency Medicine Cases Journal Jam, Rory, Anton, and I cover the evidence for (for against) using BNP in the emergency department. These are my notes...
Looking at observational data, BNP and NT-proBNP both appear to have a good sensitivities for CHF, but only moderate to poor specificities. There are a number of RCTs looking at BNP use in the emergency department setting. Two studies demonstrated a decrease in hospital length of stay and total costs, but 4 other studies showed no difference. Two studies looked at ED length of stay, 1 demonstrating a statistical but clinically insignificant difference and the other showing no difference. None of the studies demonstrated a change in ED treatment, mortality, or hospital readmission. There are a large number of problems with these studies, including the lack of a clear gold standard for CHF, a lack of blinding, incorporation bias, and spectrum bias. These problems are discussed further in the discussion section. I have never worked in an emergency department where BNP testing has been available, and after reviewing this literature I think that is probably a good thing. It is easy to get excited about tests with high sensitivities, but the use of diagnostic tests is complex and fraught with unintended consequences. I think the best evidence to date suggests that BNP testing does not provide any patient important benefit to emergency department patients."