First10EM Journal Club: December 2023

Welcome to another episode of the Emergency Medicine Journal Club with Dr Justin Morgenstern.

This month we cover a bunch of papers that look at a lot of topics and try to answer questions such as:

Can I push Keppra safely? Does BP management in haemorrhagic stroke matter? How good is my intuition about PE diagnosis? Is it a good idea to keep geriatric patients in the ED overnight? (SPOILER: it is not), Does cryoprecipitate save lives in trauma? Should we X-ray children to diagnose constipation (SPOILER: We should not!). Are you being irradiated by the portable Xray machines in your ED?

As always the paper title and PDFs are available below if you want to read the literature and make up your own mind. We highly recommend not taking the advice of a couple of blokes on the internet! 

Roussel M, Teissandier D, Yordanov Y, et al. Overnight Stay in the Emergency Department and Mortality in Older Patients. JAMA Intern Med. 2023 Nov 6. doi: 10.1001/jamainternmed.2023.5961.PMID: 37930696

Davenport R, Curry N, Fox EE, Thomas H, Lucas J, Evans A, Shanmugaranjan S, Sharma R, Deary A, Edwards A, Green L, Wade CE, Benger JR, Cotton BA, Stanworth SJ, Brohi K; CRYOSTAT-2 Principal Investigators. Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury: The CRYOSTAT-2 Randomized Clinical Trial. JAMA. 2023 Oct 12. doi: 10.1001/jama.2023.21019. PMID: 37824155 JUSTIN’s Full write up here

Choosing wisely for kids

From the American Academy of Pediatrics and the Canadian Association of Emergency Physicians, we have the Choosing Wisely recommendations for pediatric emergency medicine. The full guidelines are available in multiple locations online.) I don’t think there is anything controversial here (Choosing Wisely usually just states the way too obvious anyway),

Daneman N, Cheng Y, Gomes T, Guan J, Mamdani MM, Saxena FE, Juurlink DN. Metronidazole-associated Neurologic Events: A Nested Case-control Study. Clin Infect Dis. 2021 Jun 15;72(12):2095-2100. doi: 10.1093/cid/ciaa395. PMID: 32303736

Briggs B, Kalra S, Panacek E. Risk of Radiation Exposure to Emergency Department Personnel From Portable Radiographs. J Emerg Med. 2022 Nov;63(5):645-650. doi: 10.1016/j.jemermed.2022.08.002. Epub 2022 Oct 12. PMID: 36243611

Philpott L, Clemensen E, Lau GT. Droperidol versus ondansetron for nausea treatment within the emergency department. Emerg Med Australas. 2023 Aug;35(4):605-611. doi: 10.1111/1742-6723.14174. PMID: 36755492

Freeman JJ, Asfaw SH, Vatsaas CJ, et al. Antibiotic prophylaxis for tube thoracostomy placement in trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma. Trauma Surg Acute Care Open. 2022 Oct 25;7(1):e000886. doi: 10.1136/tsaco-2022-000886. PMID: 36312819

Ishigami J, Charleston J, Miller ER 3rd, Matsushita K, Appel LJ, Brady TM. Effects of Cuff Size on the Accuracy of Blood Pressure Readings: The Cuff(SZ) Randomized Crossover Trial. JAMA Intern Med. 2023 Aug 7:e233264. doi: 10.1001/jamainternmed.2023.3264. PMID: 37548984

van Maanen R, Martens ESL, Takada T, et al. Accuracy of physicians’ intuitive risk estimation in the diagnostic management of pulmonary embolism: an individual patient data meta-analysis. J Thromb Haemost. 2023 May 30:S1538-7836(23)00438-5. doi: 10.1016/j.jtha.2023.05.023. PMID: 37263381

You can read Casey’s extended written post on this trial here: How Good is Gestalt?

Summerlin JA, Scaturo N, Lund JA, Wang KM, Frank MA. Adverse events of undiluted intravenous push levetiracetam. Am J Emerg Med. 2023 Nov;73:182-186. doi: 10.1016/j.ajem.2023.08.046. PMID: 37708595

Marcus GM, Rosenthal DG, Nah G, Vittinghoff E, Fang C, Ogomori K, Joyce S, Yilmaz D, Yang V, Kessedjian T, Wilson E, Yang M, Chang K, Wall G, Olgin JE. Acute Effects of Coffee Consumption on Health among Ambulatory Adults. N Engl J Med. 2023 Mar 23;388(12):1092-1100. doi: 10.1056/NEJMoa2204737. PMID: 36947466

McCreary EK, Johnson MD, Jones TM, Spires SS, Davis AE, Dyer AP, Ashley ED, Gallagher JC. Antibiotic Myths for the Infectious Diseases Clinician. Clin Infect Dis. 2023 Jun 13:ciad357. doi: 10.1093/cid/ciad357. Epub ahead of print. PMID: 37310038

Ma L, Hu X, Song L, Chen X, et al; INTERACT3 Investigators. The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3): an international, stepped wedge cluster randomised controlled trial. Lancet. 2023 Jul 1;402(10395):27-40. doi: 10.1016/S0140-6736(23)00806-1. PMID: 37245517

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