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Emergency Medicine Literature of Note - Health
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April Update – Emergency Medicine Literature of Note
Periodic reminder there's lots of content over at our new home on evidencetriage.com – Such great hits as: Run A Marathon And Drop Dead Paxlovid Spiralling Into Total Disutility Can Dr. Oz Really Replace Your Doctor With AI? The Bluejepa EAGLEs Have Landed ... and many others! Every month there's a new episode of the…
(We’ve Moved) – Emergency Medicine Literature of Note
Keep up with interesting things I read on the other site: COVID-19 Vaccines Safe in Pregnancy Buy My [Unnecessary Medical Scam] Here! The "Agent" General Practitioner Clinical Trial Enrollment Via AI That Citation Doesn't Say That! We're Paying Well Over $2.5B A Year To Publish Physicians + AI = ❤️ You Don't Have to Review…
New Year, New Me? – Emergency Medicine Literature of Note
It's been a long haul for "Emergency Medicine Literature of Note" – and, as AI becomes a greater portion of my professional life, correspondingly, the time shrinks for a long-form Emergency Medicine post. So, in an experiment, I've created – and migrated to a more-modern platform – the "Medicine Minute" Substack. The hope is, with…
On the Other Site … – Emergency Medicine Literature of Note
I've taken the opportunity of reboot to try and make smaller, more digestible chunks to highlight what I'm reading – and to post more often. So, check out: The Journavx Hype Predicting Heart Failure from ECGs What's the Best Fluid for Pancreatitis? A Nice Win for Radiology AI Where Endovascular Treatment Fails Even the Best…
Are Antibiotics for Appendicitis Dead? – Emergency Medicine Literature of Note
The last decade or so featured a rather notable increase in palatability for the conservative management of appendicitis. Why undergo surgery for a condition antibiotics can cure? You wouldn't take out your bladder for a urinary tract infection, would you? This latest randomized trial adds to the evidence surrounding the "antibiotics first" strategy for appendicitis…
Variation Exists! Outcomes Exist! – Emergency Medicine Literature of Note
This little article has made the rounds, primarily by those who critique it for its many flaws. However, the underlying themes can still be valid, even if an article has limitations. This is a "there is variation in emergency physician admitting practices" article. Literally every practicing physician working in a hospital environment knows there is…
Mobile Stroke Unit Propaganda Writ Large – Emergency Medicine Literature of Note
This is yet another one of those "Get With The Guidelines" stroke analyses, a retrospective dredge with massive imbalances between groups – followed by statistical adjustments capable of turning out whichever result suits an author list with a full, dense printed page of pharma and stroke technology conflicts of interest. In that respect, the study…
The AI Will Literally See You Now – Emergency Medicine Literature of Note
This AI study is a fun experiment claiming to replicate the clinical gestalt generated by a physician's initial synthesis of visual information. The ability to rapidly assess the stability and acuity of a patient is part of every experienced clinician's refined skills – and used as a pre-test anchor for application of further diagnostic and…
Getting Triggered By Errors in the Emergency Department – Emergency Medicine Literature of Note
The emergency department is a place of risk and errors. Those who work in the ED are acutely aware of this, and it conjures up tremendous cognitive pressures on staff every shift. Every ED clinician knows the most benign-appearing triage complaint may obfuscate lurking catastrophe. The vision changes that are actually an acute aortic dissection.…
WOMAN-2: What Does the Robot Say? – Emergency Medicine Literature of Note
Following on the success of Toy Story 2, Inside Out 2, and Avatar 2, we have WOMAN-2, yet another trial featuring emergency medicine's third-favorite medication: tranexamic acid. However, where those sequels succeeded, WOMAN-2 is more like Miss Congeniality 2 – the one we're not going to talk about again. But, don't take it from me…
What are Children’s Lives Worth (to Save)? – Emergency Medicine Literature of Note
This article regarding the cost of upgrading emergency departments to be "ready" for sick children has been bouncing around in the background since its publication, with some initial lay press coverage. The general concept here is obviously laudable and the culmination of at least a decade of hard work from these authors and the team…
Get the “Human-Out-Of-The-Way” – Emergency Medicine Literature of Note
It is clear LLMs have an uncanny ability to find associations between salient features, and to subsequently use those associations to generate accurate probabilistic lists of medical diagnoses. On top of that, it can take those diagnoses and use its same probabilistic functions to mimic the explanations it has seen in its training set. A…
The Hand that Feeds the Hand that Feeds the Hand that …. – Emergency Medicine Literature of Note
Pharmaceutical development is all about the blockbuster drug. Many of our brightest minds are research scientists and bioinformaticians working at translating in vitro discoveries to improving the lives of human kind. Many of our brightest minds are also working to ensure, even if their drug candidates are – say – a little flawed, there's a…
Publication Potpourri – Emergency Medicine Literature of Note
Clearing the backlog of mildly interesting articles that will never get a full write-up – here's a quick hit of the most interesting lucky 13! "Lactated Ringer vs Normal Saline Solution During Sickle Cell Vaso-Occlusive Episodes"A "target trial emulation" providing observational evidence supporting the superiority of lactated ringers solution over normal saline for the resuscitation…
Let ChatGPT Guide Your Hand – Emergency Medicine Literature of Note
This exploration of LLMs in the emergency department is a bit unique in its conceptualization. While most demonstrations of generative AI applied to the ED involve summarization of records, digital scribing, or composing discharge letters, this attempts clinical decision-support. That is to say, rather than attempting to streamline or deburden clinicians from some otherwise time-intensive…
BIPAP IPAP: Higher is Better? – Emergency Medicine Literature of Note
The cornerstone of treatment for severe exacerbations of chronic obstructive pulmonary disease remains non-invasive positive pressure ventilation. Typically, this involves bi-level positive pressure settings, preventing alveolar collapse while assisting with inspiration and gas exchange. This works – most of the time. When it doesn't work – endotracheal intubation. This trial, the HAPPEN trial, looks at a little…
All the Pregnant Men in the EHR – Emergency Medicine Literature of Note
Electronic health records, data warehouses, and data "lakes" are treasured resources in this modern era of model training. Various applications of precision medicine, "digital twins", and other predictive mimicries depend on having the cleanest, most-accurate data feasible. One of these data sets is "All of Us", maintained by the National Institute of Health. Considering its…
The End of Respiratory Season Hell? – Emergency Medicine Literature of Note
Every year, we have our peak of respiratory viruses – traditionally influenza, respiratory syncytial virus, and their accompanying lessor demons. These are each awful, of course, in their own way from a patient- and parent-oriented standpoint, but they're also quite awful at the population level, overburdening limited pediatric and emergency department resources. RSV, in particular,…
In: Dexamethasone, Out: Prednisone – Emergency Medicine Literature of Note
Move over ketamine and TXA, there's another medication gradually approaching do-it-all darling status in Emergency Medicine: dexamethasone. Sore throats? Croup? Headaches? Non-specific aches? Well, yes to all of the above, in the appropriate clinical context – But, most prominently, as featured in this brief report, for asthma – particularly childhood asthma. It's NHAMCS – so…
The Andexxa Showpiece – Emergency Medicine Literature of Note
Every so often a masterclass performance arises in the medical literature. A performance transcending the boundaries of what was once thought possible. A shining exemplar of human achievement. This is a trial, published in the New England Journal of Medicine, with the following features: Conducted by an institute sponsored by pharma. Designed by the first…
Cancer Clinical Trials Don’t Benefit Patients – Emergency Medicine Literature of Note
Hearkening back to my former life as the chair of an Institutional Review Board: you do not promise or imply a potential for benefit to clinical trial participants. Why? Because clinical trials aren't designed to benefit participants. Participants may be randomized to the "standard of care" arm. The trial drug may not have any improvement…
When EHR Interventions Succeed … and Fail – Emergency Medicine Literature of Note
This is a bit of a fascinating article with a great deal to unpack – and rightly published in a prominent journal. The brief summary – this is a "pragmatic", open-label, cluster-randomized trial in which a set of interventions designed to increase guideline-concordant care were rolled out via electronic health record tools. These interventions were…
Quick Hit: Elders Risk Assessment – Emergency Medicine Literature of Note
A few words regarding an article highlighted in one of my daily e-mails – a report regarding the Elders Risk Assessment tool (ERA) from the Mayo Clinic. The key to the highlight is the assertion this score can be easily calculated and presented in-context to clinicians during primary care visits, allowing patients with higher scores…
Update to Start 2024 – Emergency Medicine Literature of Note
A brief post collating a few bits of my various work published across the interwebs .... The Annals of Emergency Medicine Podcast continues to summarise the meatiest articles from each month, featuring a cycle of new co-hosts, as well: Apple Podcasts Google Podcasts Soundcloud Naturally, there are continuing Journal Club features, covering the following articles: Zone 1…
Everyone’s Got ChatGPT Fever! – Emergency Medicine Literature of Note
And, most importantly, if you put the symptoms related to your fever into ChatGPT, it will generate a reasonable differential diagnosis. "So?" This brief report in Annals describes a retrospective experiment in which 30 written case summaries lifted from the electronic documentation system were fed to either clinician teams or ChatGPT. The clinician teams (either…
Don’t Use Lytics in Mild Stroke, Part 3 – Emergency Medicine Literature of Note
Well, PRISMS demonstrated unfavorable results. MARISS tried to ascertain predictors of poor outcome in mild stroke, and intravenous thrombolysis was not associated with an effect on the primary outcome. Now, again, we examine thrombolysis in "mild" stroke, in this case, NIHSS ≤3 – and fail. Like MARISS, this is a retrospective dredge of patients selected…
Which Sepsis Alert is the Biggest Loser? – Emergency Medicine Literature of Note
It’s a trick question – in the end, all of us have already lost. This is a short retrospective report evaluating, primarily, the Epic Sepsis Prediction Model, and the mode in which is deployed. The Epic SPM generates a "prediction of sepsis score", calculated at 15 minute intervals, providing a continuous risk score for the…
End Nail Dogma – Emergency Medicine Literature of Note
In a world of doors, truck beds, furniture, and other finger-crushing nuisances, emergency department visits for injuries involving the distal digits are common. Injuries range from tuft fractures, to degloving injuries, to all manner of nail and nailbed derangement. Perusing any textbook or online resource will typically advise some manner of repair, including, but not…
The Opiates in Back Pain Conundrum – Emergency Medicine Literature of Note
We do love to give out opiates in the emergency department. Kidney stone? Opiates. Broken arm? Opiates. Gunshot wound? Opiates. Sore throat? Dexamethasone. And opiates. So of course we're here with opiates for your back pain. In this modern day, we are far, far more judicious than in times of yore, back when pharma had…
The Cost of “Quality” – Emergency Medicine Literature of Note
In case you missed this beautiful little article, it's worth re-highlighting regarding the paradoxical "cost" of "quality". In theory, high-quality care is its own reward. Timely actions and interventions, thoughtful and thorough evaluations, and appropriate guideline adherence when applicable are all goals with reasonable face validity for healthcare delivery. Competing incentives, however, coupled with time…
Toss Up: A Little Bleeding, or A Lot of Platelets – Emergency Medicine Literature of Note
Platelets are the good little minions of hemostasis. In their absence, invasive procedures develop additional risk, ranging from minimal to clinically important, and the mitigation strategy ranges from avoidance, the alternative procedural techniques, to prophylactic platelet transfusions. Platelets, like any blood product, are associated significant risks, not limited to acute lung injury, transfusion-related circulatory overload,…
Anchoring on Bias – Emergency Medicine Literature of Note
The results of this paper are hardly surprising, since the witnessed phenomenon – "anchoring bias" – exists as defined. However, it's always fun to see it demonstrated objectively. In this little piece of research, authors collated four years of encounters to Veterans Affairs emergency departments in the U.S. and parsed out the triage reason between…
When ChatGPT Writes a Research Paper – Emergency Medicine Literature of Note
It is safe to say the honeymoon phase of large language models has started to fade a bit. Yes, they can absolutely pass a medical licensing examination when given carefully constructed prompts. The focus now turns to practical applications - like, in this example, using ChatGPT to write an entire scientific paper for you! There…
Fall Recap – Emergency Medicine Literature of Note
It is the long, cold dark here in Christchurch – improved dramatically by leaving for the U.S. for four weeks! Firstly, the blog may be making a bit of a comeback – the ugly demise of Twitter seems to necessitate a better method of knowledge translation, such as blog posts that can be replicated across…
Summer Recap – Emergency Medicine Literature of Note
Down here, summer has ended – although, you wouldn't know it from the 26C weather we're having outside today. But, this means it's been a few months since I've linked to my various #FOAMed resources around the web. First, and not least, the Annals of Emergency Medicine Podcast, the Ryan and Rory Show, recapping the…
Still Alive! – Emergency Medicine Literature of Note
While the blog has become a bit sparse – owing to the demands of a new environment down in New Zealand – I've got plenty of new content to share. I'm still writing bimonthly for ACEPNow: Should We Use New Blood Test to Rule Out TBI? Insights from the Pediatric Emergency Care Applied Research Network…
Intermediate-Value CTCA? – Emergency Medicine Literature of Note
Pervasive use of CT coronary angiography has been an unnecessary feature of the evaluation of patient with low-risk chest pain for the better part of a decade now. The argument behind its use – a normal examination confers a durable protective effect – is obviously nonsensical, as this bestows agency upon the test itself. Obviously,…
All Glory to the MSU – Emergency Medicine Literature of Note
It has apparently become time for the mobile stroke unit to go from niche to prime-time. Previously consigned to the pages of Stroke and similar journals, the latest and most comprehensive trial now graces the pages of the New England Journal of Medicine. A flagship study for a flagship journal. Not to mention, a positive…
It’s Not OK To Let 25% of tPA Cases Be Stroke Mimics – Emergency Medicine Literature of Note
With all the various competing interests for time, it's rare to find an article of sufficient note to warrant its own blog post. A notable publication might get a short tweet thread. Collections of other literature find their way into ACEPNow articles or the odd Annals of Emergency Medicine Journal Club. But, every once in…
Minor Stroke is Our Favorite Stroke – Emergency Medicine Literature of Note
While most facilities are using non-contrast CT, CT angiograms, and/or CT perfusion as part of their initial triage of possible stroke, there are a few using rapid MRI-based protocols. MRI is vastly superior to CT for its specificity for stroke, quite useful in reducing early diagnostic closure and unnecessary treatment with thrombolytics. One of these…