One of the downsides of subscribing to more than 50 journal feeds is the huge number of interesting papers that I flag for later, but never find time to return to. I have started clearing out old PDFs for papers I never found time to fully appraise, but I figured that if the titles caught my eye, you might find them interesting as well. I have not fully appraised these papers. I have scanned them once. Don’t take my summaries as definitive. If something catches your eye, grab the paper and read it for yourself before making any practice changes. (Really, I suggest doing that even when I write a full appraisal.)
Metronidazole for PID?
Wiesenfeld HC, Meyn LA, Darville T, Macio IS, Hillier SL. A Randomized Controlled Trial of Ceftriaxone and Doxycycline, With or Without Metronidazole, for the Treatment of Acute Pelvic Inflammatory Disease. Clin Infect Dis. 2021 Apr 8;72(7):1181-1189. doi: 10.1093/cid/ciaa101. PMID: 32052831
An RCT of 233 women found that the addition of metronidazole to ceftriaxone and doxycycline decreased lab based outcomes (growth of Mycoplasma genitalium and anaerobes) at 30 days, but had no difference on clinical outcomes. It’s a borderline benefit, and I will probably defer to my local guidelines on this decision.
C diff in children
Tougas SR, Lodha N, Vandermeer B, Lorenzetti DL, Tarr PI, Tarr GAM, Chui L, Vanderkooi OG, Freedman SB. Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children: A Systematic Review and Meta-analysis. JAMA Pediatr. 2021 Oct 1;175(10):e212328. doi: 10.1001/jamapediatrics.2021.2328. Epub 2021 Oct 4. PMID: 34338715
I am not sure that I knew that we were not supposed to test infants for C. Diff, but that is apparently in IDSA guidelines. This systematic review and meta-analysis tells you why: colonization among asymptomatic infants was as high as 41% (14% toxigenic strain), and it remains relatively high (12% or 6% toxigenic strain) in the 5-18 year group.
Alternative ‘medicines’ are not safe (and not effective)
Grusche F, Egerton-Warburton D. Traumatic Pneumothorax Following Acupuncture: A Case Series. Clin Pract Cases Emerg Med. 2017 Jan 23;1(1):31-32. doi: 10.5811/cpcem.2016.11.32757. PMID: 29849396
“What’s the harm” is one of the most common (and most stupid) arguments in favour of quack therapies like homeopathy and acupuncture. I have personally seen multiple pneumothoracies from acupuncture in my career, and this paper reports on 3 such cases. Just a nice reminder that despite having absolutely no benefit, all of these imitation medicines can cause significant harm.
Don’t call it a comeback; I’ve been here for years
Larkin H. WHO Report: Cholera Resurgent in 2022 After Years of Decline. JAMA. 2023 Jan 17;329(3):200. doi: 10.1001/jama.2022.23551. PMID: 36648460
Not a scientific paper, but just note of the WHO report indicating that Cholera numbers have increased for the first time in years, and that we are doing a poor job managing outbreaks, with case-fatality numbers higher than expected (1.9% globally and 2.9% in Africa). Climate change and violent conflict are the primary contributors.
I’ve always been a bit of a sucker for a casino
Levin H, Lim R, Lynch T, Sangha G. Improving Resident Well-Being During Shiftwork: Are Casino Shifts the Answer? Pediatr Emerg Care. 2019 Dec;35(12):852-855. doi: 10.1097/PEC.0000000000001990. PMID: 31790073
The evidence for casino shifts is relatively strong (although I have never worked in a place that uses them). This is a randomized trial of casino shifts versus standard night shifts in residents which showed no benefit, and I thought it might be interesting to compare the results the the other studies showing benefit for more insight into this practice. I may come back to this topic in the future, but haven’t found time yet.
Air pollution is still a problem
Liu C, Chen R, Sera F, Vicedo-Cabrera AM, et al. Ambient Particulate Air Pollution and Daily Mortality in 652 Cities. N Engl J Med. 2019 Aug 22;381(8):705-715. doi: 10.1056/NEJMoa1817364. PMID: 31433918
At some point I might still do a full post on air pollution, because there is some really fascinating research looking at air pollution and cognitive performance levels, but for now I will clear my files of this paper looking at data from 652 cities, and showing a significant association between days with more air pollution and increased all cause mortality. I know emergency medicine is already tasked with doing everything, but addressing environmental sources of illness might actually make our departments less busy while making our cities healthier, so is probably worthy of our attention.
Body bag to save lives
Wang AZ, Lupov IP, Sloan BK. A Novel Technique for Ice Water Immersion in Severe Drug-Induced Hyperthermia in the Emergency Department. J Emerg Med. 2019 Nov;57(5):713-715. doi: 10.1016/j.jemermed.2019.08.041. Epub 2019 Oct 16. PMID: 31629579
I think this concept has been circulated widely enough that I don’t need to perform a full write up, and considering it is just 2 case reports, it obviously isn’t great science. One good method to cool people rapidly is to place them in a body bag and fill it with ice water.
Incidental findings on FAST exam
Valenzuela J, Stilson B, Patanwala A, Amini R, Adhikari S. Prevalence, documentation, and communication of incidental findings in focused assessment with sonography for trauma (FAST) examinations. Am J Emerg Med. 2020 Jul;38(7):1414-1418. doi: 10.1016/j.ajem.2019.11.040. Epub 2019 Nov 28. PMID: 31836347
I have already made my feelings about the FAST exam very clear. One issue I didn’t emphasize is that using any test indiscriminately as a screening tool will result in incidental findings. This retrospective review of 1452 FAST exams found that there were incidental findings in about 10% of patients. Perhaps it is good for patients that only 21% of these were documented, and only 5% of patients were told about the findings?