In the Literature: HM-Related Research You Need to Know
Bottom line: Noncontrast CT has a high sensitivity and specificity for acute appendicitis, and should be considered an alternative to contrast CT, particularly in patients with contraindications to contrast or those at risk of contrast-induced nephropathy.
Citation: Hlibczuk V, Dattaro JA, Jin Z, Falzon L, Brown MD. Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review. Ann Emerg Med. 2010;55(1):51-59.e1.
In a study of Toronto hospitals, ED length of stay was longer if the number of inpatient admissions exceeded discharges on the previous day; balancing this ratio might improve ED crowding.
Citation: Vermeulen MJ, Ray JG, Bell C, Cayen B, Stukel TA, Schull MJ. Disequilibrium between admitted and discharged hospitalized patients affects emergency department length of stay. Ann Emerg Med. 2009;54(6):794-804.
TWO OR MORE MEDICAL ERRORS ARE ASSOCIATED WITH INTENSIVE-CARE-UNIT DEATHS
A multicenter observational study found that two or more medical errors were associated with a threefold increase in ICU mortality; the study suggests 14 specific errors as potential quality indicators.
Citation: Garrouste-Orgeas M, Timsit JF, Vesin A, et al. Selected medical errors in the intensive care unit: results of the IATROREF study: parts I and II. Am J Respir Crit Care Med. 2010;181(2):134-142.
AGE AND GENDER PREDICT MORTALITY FOLLOWING AAA REPAIR
A retrospective study suggests reconsideration of the 5.5-cm cutoff for abdominal aortic aneurysm (AAA) repair; age and gender can predict the risk of postoperative mortality, which might outweigh the natural risk of AAA rupture.
Citation: Schlösser FJ, Vaartjes I, van der Heijden GJ, et al. Mortality after elective abdominal aortic aneurysm repair. Ann. Surg. 2010;251(1):158-164.
ADVANCED DIRECTIVES FOR ONCOLOGY PATIENTS ARE INSUFFICIENTLY ADDRESSED
Among 75 oncology inpatients, 95% thought advanced directives (ADs) were important, but 41% had an AD, only 23% wanted a discussion with their oncologist, and only 7% had discussed ADs with their oncologist prior to admission.
Citation: Dow LA, Matsuyama RK, Ramakrishnan V, et al. Paradoxes in advance care planning: the complex relationship of oncology patients, their physicians, and advance medical directives. J Clin Oncol. 2010;28(2):299-304.
A MINIMUM OF 60 ML OF PLEURAL FLUID IS RECOMMENDED TO DIAGNOSE MALIGNANCY
In this prospective study of 102 patients with suspected or known malignant pleural effusions, thoracentesis samples ≥60 mL were adequate to diagnose malignancy by direct smear or cytospin.
Citation: Swiderek J, Morcos S, Donthireddy V, et al. Prospective study to determine the volume of pleural fluid required to diagnose malignancy. Chest. 2010;137(1):68-73.
THROMBOPROPHYLAXIS AMONG SURGICAL PATIENTS REMAINS UNDERUTILIZED
In a cross-sectional study of more than 18,000 patients undergoing major surgery in 32 countries, thromboprophylaxis was underutilized: 92% of patients were at risk for VTE, but only 62% received American College of Chest Physician-recommended prophylaxis.
Citation: Kakkar AK, Cohen AT, Tapson VF, et al. Venous thromboembolism risk and prophylaxis in the acute care hospital setting (ENDORSE survey): findings in surgical patients. Ann Surg. 2010;251(2):330-338.
SURGERY MIGHT BE AN IDEAL TIME TO HELP SMOKERS QUIT
In a longitudinal study of 5,498 older U.S. adults, major surgery was associated with a twofold increase in smoking cessation, suggesting that surgery is an opportune time for cessation interventions.
Citation: Shi Y, Warner DO. Surgery as a teachable moment for smoking cessation. Anesthesiology. 2010;112(1):102-107.
CONCERN FOR UNSUSPECTED COAGULOPATHY SHOULD NOT DELAY TPA IN ACUTE ISCHEMIC STROKE
In this retrospective study of 470 acute ischemic strokes, only 0.4% of patients had unsuspected coagulopathy, supporting guidelines that if coagulopathy is not suspected, tPA may be initiated prior to clotting test availability.
Citation: Rost NS, Masrur S, Pervez MA, Viswanathan A, Schwamm LH. Unsuspected coagulopathy rarely prevents IV thrombolysis in acute ischemic stroke. Neurology. 2009;73(23): 1957-1962.
