Clinical Predictors of Pneumonia Among Children with Wheezing Key point: The routine use of chest radiography for children with wheezing but without fever should be discouraged. Citation: Mathews B, Shah S, Cleveland RH, et al. Clinical predictors of pneumonia among children with wheezing. Pediatrics. 2009; 124(1): e29-e36. A prospective cohort study was performed with children < 21 year of age who were evaluated in the ED, were found to have wheezing on examination, and had …
Read MoreAbstracts – November 2009
Cost and Quality of Care at Retail Clinics Key point: Quality scores at retail clinics rivaled those at urgent care centers, physician offices, and EDs. Citation: Mehrotra A, Liu H, Adams JL, et al. Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses. Ann Intern Med. 2009; 151(5): 321-328. Professional organizations have raised concerns about the quality of care that is delivered at store-based retail …
Read MoreAbstracts in Urgent Care: October, 2009
Another Validation of Clinical Assessment and D-Dimer to Rule Out PE Key point: Among patients with low or intermediate risk, the sensitivity and negative predictive value of D-dimer testing were 100%. Citation: Gupta RT, Kakarla RK, Kirshenbaum KJ, et al. D-dimers and efficacy of clinical risk estimation algorithms: Sensitivity in evaluation of acute pulmonary embolism. AJR Am J Roentgenol. 2009; 193: 425-430. Despite research showing that clinically important pulmonary embolism (PE) can be excluded when …
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H1N1 Update: CDC Recommends Seasonal Flu Vaccination for Children Over 6 Months Key point: Get vaccinated! Citation: Fiore AE, Shay DK, Broder K, et al. Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR. July 24, 2009; 58 (Early Release): 1-52. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm. In contrast to last year, when seasonal flu shots for those between 6 months and 18 years of age were “encouraged,” …
Read MoreAbstracts in Urgent Care: July/August, 2009
Early Estimate of Pandemic Potential of Influenza A H1N1 “Swine Flu” Key point: The current virus is transmitted efficiently but probably is less lethal than past pandemic viruses. Citation: Fraser C, Donnelly CA, Cauchemez S, et al. Pandemic potential of a strain of influenza A (H1N1): Early findings. Science. 2009 May 14; e-pub ahead of print. A team of epidemiologists has analyzed the influenza A (H1N1) epidemic in Mexico. Data related to the outbreak were …
Read MoreAbstracts in Urgent Care: June, 2009
Incidence of AMI in Patients with Syncope Key point: In a cohort study of nearly 1,500 patients presented without ST-segment elevation. Citation: McDermott D, Quinn JV, Murphy CE. Acute myocardial infarction in patients with syncope. CJEM. 2009; 11: 156-160. Which patients with syncope require hospital admission? To answer this question, researchers studied the incidence of acute myocardial infarction within 30 days of presentation in a cohort of 1,474 consecutive emergency department patients who presented with …
Read MoreAbstracts in Urgent Care – May 2009
Occult Bacteremia is Rate in Young Children with Unexplained Fever Key point: Since introduction of the pneumococcal vaccine, urinary tract infection has become the most common bacterial infection in children who have fever without localizing signs. Citation: Waddle E, Jhaveri R. Outcomes of febrile children without localizing signs after pneumococcal conjugate vaccine. Arch Dis Child. 2009; 94: 144-147. Occult bacteremia and invasive disease are important concerns in children with unexplained high fever. Investigators retrospectively compared …
Read MoreAbstracts in Urgent Care: April, 2009
Should the Elbow Extension Test Be Used to Rule Out Bony Injury? Key point: Full elbow extension had a negative predictive value for fracture of 98.4% in adults and 95.8% in children. Citation: Appelboam A, Reuben AD, Benger JR, et al. Elbow extension test to rule out elbow fracture: Multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. BMJ. 2008; 337: a2428. The objective of this study was to determine whether …
Read MoreAbstracts in Urgent Care – March 2009
Beware of Eyewitness Accounts of Syncope or Seizures Key point: Bystanders’ descriptions of acute neurologic events often are simply wrong. Citation: Thijs RD, Wagenaar WA, Middelkoop HAM, et al. Transient loss of consciousness through the eyes of a witness. Neurology. 2008; 71: 1713-1718. Diagnosis of sudden catastrophic illness depends a good deal on eyewitness accounts. But, as criminologists know, eyewitnesses can be unreliable. Now, a team of neurologists in the Netherlands has reconfirmed this finding. …
Read MoreAbstracts in Urgent Care: January 2009
Who Needs a Blood Culture in the ED? Key point: Use of a prediction rule might reduce use of cultures in low-risk patients. Citation: Shapiro NI, Wolfe RE, Wright SB, et al. Who needs a blood culture? A prospectively derived and validated prediction rule. J Emerg Med. 2008; 35(3): 255-264. Although blood cultures often are obtained for patients in the emergency department, little evidence is available to guide patient selection for such testing. Currently, general …
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