Category Archives: Papers of the week

Important studies / research papers relevant to Emergency Medicine

paper of the week

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Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism

JAMA. 2021;326(21):2141-2149. doi:10.1001/jama.2021.20750

 Overview

  • Combination of PERC, YEARS and age adjusted DDimer has been reviewed regarding the use of advacnced imaging and detection of PE in comparison to the classical pathway (definition below)

Bottom line

  • Inclusion of YEARS criteria in workup of VTE patients can be valuable to reduce chest imaging
  • This study is not specific for pregnant patients, further clinical trials will be required

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Intranasal Topical Application of Tranexamic Acid in Atraumatic Anterior Epistaxis

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Original paper

 

 

 

Findings

  • Intranasal topical TXA is associated with a lower rate of need for anterior nasal packing and a shortened stay in the ED

Bottom line

  • Topical TXA for epistaxis is slowly gaining traction despite recent negative study (NoPAC)
  • This RCT fits author’s own experience- ineffective for posterior bleeding, delayed presentations or traumatic epistaxis, but no harm and better tolerated than balloon tamponade device (RapidRhino etc)

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Efficacy of empiric abx for septic olecranon bursitis without aspiration in ED

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Findings

  • In this series, 84% of patient was discharged from ED, 55.3% with antibiotic. Only 1.5% had elbow aspiration in ED. 88% had resolution at follow-up.

Bottom line

  • Author concluded that aspiration in ED is not necessary even when septic bursitis is suspected, and most can be managed with outpatient antibiotic
  • Performing a CRP blood test, and/or referral to orthopedic service, is associated with admission and antibiotic administration
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Ketamine vs Midazolam/ Haloperidol for acute agitation

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Original paper here

What is this study about

  • Authors hypothesized that given intramuscularly, Ketamine would work quicker (and safer) when compare to traditional benzodiazepine and antipsychotic medication.
  • This is a RCT based on ED patients at a Canadian hospital in Vancouver
  • Although ED diagnosis is not stated, the age of these patients and prior history suggest primary mental health disorder and drug/ alcohol plays a big role in their acute agitated state.

Bottom line

  • Study is underpowered due to COVID-19 outbreak. In this RCT ketamine is about 3x faster to produce clinical effect compared to study drug. Lack of statistical evidence due to underpowered study, and lack of reporting of subsequent outcome (need for redosing, emergent phenomenon) limits the application of this study to day-to-day clinical practice.
  • Choice of chemical sedation for acutely agitated patient in the ED, is still determined by individual clinician preference and familiarity.

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Conservative versus Interventional Treatment for Spontaneous Pneumothorax

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Conservative versus Interventional Treatment for Spontaneous Pneumothorax

Bottom line

Conservative management of stable unilateral, spontaneous primary pneumothorax, is not inferior to Seldinger drain, with lower risk of serious adverse events.

Majority of patient with unilateral primary spontaneous pneumothorax is safe for conservative management and discharge at 4 hrs, after a repeat CXR

High fragility index due to lost to follow-up means data is not statistically robust

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