Welcome to the 101st edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.
This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the : Overview; Archives and Contributors
This Edition’s R&R Hall of Famer
Chabok A et al. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012; 99(4): 532-9. PMID: 22290281
- This is a multicentre RCT of 623 adult patients with CT confirmed uncomplicated diverticulitis (defined as lower abdo pain plus fever, an elevated WBC, and CT consistent with diverticulitis but no abscess or free air). Patients were randomized to either antibiotics or not. They used pretty big gun antibiotics: either a 2nd/3rd gen cephalosporin plus metronidazole or a carbapenem or piperacillin-tazobactam. There were no statistical differences between the groups. There were 3 perforations in each group. There were 3 abscesses in the no antibiotics group compared to none in the antibiotics group. 10 patients (3.2%) that started with no antibiotics were given antibiotics eventually. There were no differences in length of hospital stays or recurrent diverticulitis. Bottom line: It may well be that we don’t need antibiotics for diverticulitis, but these patients were all treated as inpatients, so its probably not up to us to make that call.
- Recommended by: Justin Morgenstern
Cohn B. Are Prophylactic Antibiotics Necessary for Anterior Nasal Packing in Epistaxis? Ann Emerg Med 2014. PMID: 25220955
- Epistaxis is a common presenting complaint in the ED and anterior nasal packing is a frequent solution. Standard treatment after packing is to provide antibiotics as prophylaxis against the development of toxic shock syndrome. However, the evidence behind this dogma is scarce. This article reviews the evidence and concludes that the harms of prophylactic antibiotics likely outweighs the benefits and that withholding antibiotics may be very reasonable.
- Recommended by: Anand Swaminathan
Silver SA et al. Risk prediction models for contrast induced nephropathy: systematic review. BMJ 2015. PMID: 26316642.
- This is a large systematic review exploring the ability of models to predict iodinated contrast induced nephropathy (CIN). Twelve prediction models were identified with varying degrees of validation. Most of these included similar risk factors as baseline renal dysfunction, diabetes, heart failure and hemodynamic compromise at the moment of the contrast administration. There is large heterogeneity in the ability to predict CIN, with some of the models with an excellent ability to do so, however these typically include the amount of volume used in the study, a variable only known post-hoc. Importantly, these predictive tools are mainly based on data from angiographic procedures instead of CT imaging. None of the models explored has been used consistently in clinical practice. As bottom line, we still don’t know and can’t predict who is going to develop CIN from a regular CT (versus angiography), but probably patients with GFR <30 are at increased risk.
- Recommended by: Daniel Cabrera
Cohen-Silver JH et al. Autism in the emergency department. Clin Pediatr 2014; 53(12): 1134-8. PMID: 25031320
- Sometimes we need adjust our approach to a patient’s management in order to avoid exacerbating the problem. There are many clinical scenarios when this is true, but is especially important to consider when dealing with patients who have autism.
- Recommended by: Sean Fox
Piazza G et al. A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. JACC Cardiovasc Interv. 2015; 8(10): 1382-92. PMID: 26315743
- Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis decreased RV strain/dysfunction with zero cases of intracranial hemorrhage in patients with acute massive and submassive PE.
- Recommended by: Salim R. Rezaie
Bauer IL. Candiru–a little fish with bad habits: need travel health professionals worry? A review. J Travel Med 2013; 20(2): 119-24. PMID: 23464720
- This is one of those really weird medical myths that I heard when I was younger and just stuck with me as a true. Apparently if you urinate in the Amazon river, there are little fish, called Candiru, that are attracted to the urine and will swim up your urethra. Once there, they have small barbs that lock them into place. These authors did an extensive review of both the scientific and non-scientific literature and report that there has never actually been a confirmed case of this occurring. For some reason, that is an amazing relief to me (and I have never even been to South America). Was I the only one raised on this particular myth?
- Recommended by: Justin Morgenstern