R&R In The FASTLANE 120

Welcome to the 120th 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

Swaminathan A et al. The Safety of Topical Anesthetics in the Treatment of Corneal Abrasions: A Review. J Emerg Med. 2015. Nov;49(5):810-5. PMID 26281814

• An amazing review by a few of our very own. Could our fear of topical anesthetics in simple corneal abrasions be based on a myth? This review found 6 RCTs that indicate topical anesthetics are effective for pain control. Although small RCTs are not enough to prove safety, there are plenty of reasons to think this might be a myth.
• Recommended by Justin Morgenstern

Stollman N et al. American Gastroenterological Association Institute Guideline on the Management of Acute Diverticulitis. Gastroenterology 2015;149(7):1944-9 PMID 26453777

• New guidelines for treatment of uncomplicated diverticulitis reflect two randomized trials and one observational series suggesting antibiotics confer no routine benefit.
• Recommended by Ryan Radecki

Ralston SL et al. A Multicenter Collaborative to Reduce Unnecessary Care in Inpatient Bronchiolitis. Pediatrics 2016; 137(1): 1-9. PMID 26628731

• An intensive quality improvement intervention greatly diminished unnecessary resource utilization in the context of bronchiolitis care at most, but not all, hospitals involved.
• Recommended by Ryan Radecki

Holler JG et al. Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review. PLoS One. 2015; 10(3): e0119331, PMID 25789927

• This review aims at establishing epidemiological characteristics of nontraumatic hypotension (SBP ≤ 90 mmHg) and shock (any definition + and SBP ≤ 90 mmHg) in the ED and prehospital setting. Based on evaluation of 11880 papers 6 observationel studies (1000 patients) were identified all with a high risk of bias. Among these 1000 patients prehospital prevalence of hypotension was 2% and hypotensive shock was 1-2 % with an inhospital mortality of shock between 33 to 52%. ED prevalence of hypotension was 1% contacts with a mortality of 12%. There were insufficient data to perform a meta-analysis.
• Recommended by Soren Rudolph

Edwards A. Top 10 TARN research publications. Emerg Med J 2015; 32(12):966-8. PMID 26598632

• Celebrating 25 years of TARN (Trauma Audit and Research Network database) research. What have we learned from the vast amounts of data collected:
  – Patients with severe head injury should be treated at a neuro surgical center
  – Elderly patients do worse and at risk for Porum management, perhaps due to more complex presentation of injury.
  – Patients on warfarin do worse
  – The interrelationship between vital signs in hemorrhagic shock is not supported to extend suggested by the ATLS classification.
  – How data can be standardized to compared perfomance between institutions
  – That GCS scale as a clinical tool fir risk assessment, classification and prognosis plays an significant role in the improvement of head injury outcome.
• Recommended by Soren Rudolph

efferies S et al. Randomized controlled trial of the effect of regular paracetamol on influenza infection. Respirology 2015. PMID 26638130

• In a grossly underpowered study, paracetamol had no observable effects on physiologic or viral parameters in influenza infection – which led these authors to somehow conclude acetaminophen has no value at all.
• Recommended by Ryan Radecki