A New Approach to Managing Young Non-Toxic-Appearing Febrile Children Keypoint: Researchers suggest an emphasis on more limited evaluation, now that vaccines have greatly reduced the likelihood of serious bacterial infections. Citation: Jhaveri R, Byington CL, Klein JO, Shapiro ED. Management of the non-toxic-appearing acute lyfebrile child: a  21stcentury approach. J Pediatr. 2011;59(2):159:181. Since the 1970s, considerable attention has been paid to the management of febrile children aged £3 years without an obvious focus of infection. …
Read MoreAbstracts in Urgent Care: September, 2011
Antibiotics Are Not Equal to Appendectomy for Appendicitis Keypoint: The incidence of peritonitis at 30 days was higher in the antibiotic group than in the surgery group; 68% of patients treated with antibiotics did not require appendectomy Citation: Vons C, Barry C, Pautrat K, etal. Amoxicillinplus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, ran- domised controlled trial. Lancet. 2011;377(9777): 1573-1579. Four recent randomized trials suggest that antibiotics alone can …
Read MoreAbstracts in Urgent Care: July/August, 2011
Heparin-Binding Protein: A New Biomarker for Bacterial Meningitis Key point: A cerebrospinal fluid HBP level >20 ng/mL was 100% sensitive and 99.2% specific for bacterial meningitis in adults. Citation: Linder A, Akesson P, Studahl M, et al. Heparin- binding protein: a diagnostic marker of acute bacterial meningitis. Crit Care Med. 2011;39(4):812-817. To assess whether cerebrospinal fluid (CSF) levels of heparin- binding protein (HBP) can predict bacterial meningitis, re- searchers analyzed CSF samples in a prospective …
Read MoreAbstracts in Urgent Care: June, 2011
When Should Diagnostic Imaging Be Used for Patients With Low-back Pain? Key point: With low-back pain, the risks associated with X-rays and MRIs often outweigh the benefits. Citation: Daily POEM: imaging for low-back pain: rarely indicated, often harmful. Available at: www.essentialevidience- plus.com. These guidelines are based on a systematic review and meta- analysis of research investigating the usefulness of various im- aging studies in patients with low-back pain. Based on a meta- analysis of six …
Read MoreAbstracts in Urgent Care: May, 2011
Complications of Sinusitis in Children Key point: Intracranial complications of pediatric sinusitis were more severe than intraorbital complications. Citation: Goytia VK, Giannoni CM, Edwards MS. Intraorbital and intracranial extension of sinusitis: Comparative morbidity.  J Pediatr. 2011;158(3):486-491. Serious complications of sinusitis occur more often in children than in adults. Prompt diagnosis and treatment are necessary to minimize morbidity and the risk for permanent sequelae or death. In arecent study, investigators reviewed records from a large chil- …
Read MoreAbstracts in Urgent Care: April, 2011
Randomized Controlled Trial of Cephalexin Versus Clindamycin for Uncomplicated Pediatric Skin Infections Key point: When it comes to curing skin infected with MRSA (methicillin-resistant Staphylococcus aureus), timely and proper wound cleaning and draining may be more important than the choice of antibiotic. Citation: Chen AE, Carroll KC, Diener-West M, et al. Pediatrics. 2011;127(3):e573-e580. Researchers originally set out to compare the efficacy of two antibiotics commonly used to treat Staph skin infections, ran- domly giving 191 …
Read MoreAbstracts in Urgent Care: March, 2011
Not All Infectious Diseases Society of America Practice Guidelines Are Created Equal Key point: More than 1/2 of recommendations in guidelines from the Infectious Diseases Society of America rely on low-quality evidence. Citation: Lee DH, Vielemeyer O. Analysis of overall level of evidence behind Infectious Diseases Society of America practice guidelines. Arch Intern Med. 2011;171(1):18-22. Researchers examined 41 guidelines published by the Infectious Diseases Society of America (IDSA) since 1994. Of the 4,200 in- dividual …
Read MoreAbstracts in Urgent Care: February, 2011
Most Frequently Missed Fractures in the Pediatric Emergency Department Key point: The most commonly missed fractures were pha- langes of the hand and metatarsal fractures. Citation: Mounts J, Clinenpeel J, McGuire E, et al. Most frequently missed fractures in the emergency department. Clin Pediatr (Phila). 2010 Dec 2. [Epub ahead of print.] This study quantified the types of extremity fractures most commonly missed on plain radiographs by pediatric emer- gency medicine specialists after an initial …
Read MoreAbstracts in Urgent Care: January, 2011
Position Statement on Sports Concussions Key point: Sports are second only to motor vehicle accidents as the leading cause of traumatic brain injury among 15- to 24- year-olds. Citation: AAN Sports Neurology Section, Practice Committee, and Board of Directors. Position statement on sports concus- sion. October 2010 (AAN Policy 2010-36). Concussion is a common consequence of trauma to the head in contact sports, estimated by the Centers for Disease Control and Prevention to occur 3 …
Read MoreAbstracts in Urgent Care: December, 2010
Nahum Kovalski, BSc, MDCM Each month, Dr. Nahum Kovalski reviews a handful of abstracts from, or relevant to, urgent care practices and practitioners. For the full reports, go to the source cited under each title. New Guidelines for Prevention of Stroke in Patients with Stoke or TIA Key point: New, evidence-based recommendations aim at reducing risk of ischemic stroke in patients who have had a stroke or transient ischemic attack. Citation: Furie KL, Kasner SE, …
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