By now, everyone has (unfortunately) heard about the PESIT trial. Given the many commentaries in the FOAM community, we are all familiar with the many reasons that the widely quoted 1 in 6 figure probably does not apply to our patients. If you need a reminder, I summarize the paper as part of this post, or you can read a more elegant post by Rory Spiegel here. For me, the biggest issue was that PESIT never passed the sniff test. We see a ton of syncope patients. There are massive syncope databases. And nowhere have we seen massive numbers of patients returning with PE.
A research letter was just published yesterday in JAMA that gives us another take on the issue: Continue reading “Quick PESIT update”
An overview of the evidence for D-dimer use in the diagnosis of aortic disection
I am really excited to announce that we are starting a new format on the EMCases Journal Jam podcast series. The plan is to take important questions about everyday clinical practice and do a deep dive into the literature to provide you with the most evidence based answer we can come up with. Most importantly, we are adding new (or, I suppose you might argue, our first ever) talent to the series: the brilliant @EMNerd_ himself, Dr. Rory Spiegel!
The first episode has just gone live. Our question: Is there a role for D-dimer testing in the workup of aortic dissection in the emergency department? I would suggest the podcast as the more entertaining and succinct way to get an answer, but because of time restraints and our desire not to bore you to death, we did not discuss every single study in the podcast. What follows are my notes for the podcast – a brief review of all the original literature I could find on the topic, arranged by year of publication. Continue reading “D-dimer for aortic dissection: the evidence”