Intro: This 2008 study was the second large validation study of the Pulmonary Embolism Rule Out Criteria (PERC) rule. The researchers aimed to test the hypothesis that follows: patients who presented with signs and symptoms of PE but were estimated to be low risk by clinician gestalt (<15% pretest probability), in addition to being PERC negative, would have a <2% risk of VTE. Less than 2% was determined to be the point of equipose, where the dangers of workup for PE in this group (radiation exposure, incidentaloma findings) would be greater than the risk of actually finding a clinically ..read more

The Study This was a retrospective analysis using the population-based data of 6 US states from the State Emergency Department Databases and State Inpatient Databases from 2006 through 2012 to identify adults discharged from the ED with a diagnosis of atraumatic headache (which included tension headache, migraine, headache, acute headache, head pain) or back pain (which included lumbar disc herniation, nonspecific disc herniation, back pain including thoracic pain, lumbar back pain or sciatic, thoracic strain, lumbar strain, back strain). There was also a control group of patients with non-neu ..read more

The Article: The Ottawa Subarachnoid Hemorrhage Clinical Decision Rule for Classifying Emergency Department Headache Patients, AJEM 2019 The Idea: This was another study created to evaluate the Ottawa SAH (OSAH) clinical decision rule which was derived from an initial 2010 Perry paper. Since the derivation, this rule has been evaluated with very high sensitivity in several papers (2013 JAMA, 2015 AJEM). The Study: Single-center Taiwanese retrospective cohort study from Jan 2016-March 2017 Looked at patients with the primary complaint of an atraumatic headache 2 objectives: assess the OSAH r ..read more

The Article: Cerebral ischemia and deterioration with lower blood pressure target in intracerebral hemorrhage by Andrew B. Buletko, MD, et al. Neurology, 2018. The Takeaway: Lower systemic blood pressures in patients with acute intracerebral hemorrhage (ICH) were associated with worse ischemia on MRI and neurological deterioration, characterized by a worsening of NIHSS score during their hospital stay. Methods: 286 patients with acute intracerebral hemorrhage were included in the study. The study enrollment period straddled the date the institution changed their ICH blood pressure target from ..read more

A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation – The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Investigators Published in the New England Journal of Medicine on December 5 2002 Atrial fibrillation is the most common sustained cardiac arrythmia. Most symptoms during atrial fibrillation are caused by poorly controlled or irregular ventricular rate. Two different treatment approaches: 1. Rhythm control: use of antiarrythmic drugs (amiodarone, sotalol, flecainide, etc) in order to convert to sinus rhythm. Theoretical benefits ..read more

This study looked to see how both the ROCHESTER and Philadelphia Criteria do at catching INVASIVE bacterial infections. Most of the risk stratifications scores in patient between 28-60 days look for serious infections which include UTI amongst others, but none actually specify for bacteremia or meningitis. This study uses a case-control method to retroactively look at its ability to predict low-risk infants using these scores to detect invasive infections. The charts were selected based on certain criteria: + blood cultures, + LP, or pleocytosis after Abx and meningitis. These patients coul ..read more

The Article: Probiotics to Prevent Clostridium difficile Infection in Patients Receiving Antibiotics Joshua Z Goldenberg, ND; Dominik Mertz, MD; Bradley C. Johnston, PhD A JAMA Clinical Evidence Synopsis summary of Cochrane review article of 31 articles The Clinical Question: In adults and children prescribed antibiotics, is co-administration of a probiotic associated with a lower risk of symptomatic C. diff infection without an increase in adverse events? The Evidence: Clinical trials sited: 39 (33 adults, 6 peds) Study years: 1988-2012 Number of patients: 9955 Setting: inpatient, outpa ..read more

Sheen et al. Performance of Low-Dose Perfusion Scintigraphy and CT Pulmonary Angiography for Pulmonary Embolism in Pregnancy. CHEST; 2018 Pulmonary embolism is a low incidence, high morbidity diagnosis with a relatively non-specific presentation in pregnant women. In the general population, the d-dimer remains the screening laboratory value for pulmonary embolism, but this test loses its value in pregnancy. A retrospective cohort study at the Montefiore system asked if low-dose perfusion scanning (LDQ) could replace CT pulmonary angiography (CTPA) in excluding pulmonary embolism. The primary o ..read more

The Article: Are Patients Receiving the Combination of Vancomycin and Piperacillin-Tazobactam at Higher Risk for Acute Renal Injury? Luther MK, Timbrook TT, Caffrey AR, et al. Vancomycin plus piperacillin-tazobactam and acute kidney injury in adults: a systematic review and metaanalysis. Crit Care Med. 2018;46:12-20 The Idea: Vanc and zosyn in combination is a common regimen for broad-spectrum antimicrobial therapy, especially in critically ill patients. Studies have shown a 6.5-fold increase in mortality among hospitalized and critically ill patients with AKI. Many medications, including vanc ..read more

Bottom Line: When cervicitis or pelvic inflammatory disease (PID) is suspected in young, healthy women, a pelvic exam does not change sensitivity or specificity when compared to history alone. The Article: The Additive Value of Pelvic Examinations to History in Predicting Sexually Transmitted Infections for Young Female Patients With Suspected Cervicitis or Pelvic Inflammatory Disease.Ann Emerg Med. December 2018. The Idea: Gonorrhea and Chlamydia are very common in cervicitis and pelvic inflammatory disease in women ages 15-24 years old. However, there is no specific history, physical exam, o ..read more