The proportion of patients with skin and soft tissue abscesses that are sedated is low, according to one study. Females and patients with employer-based insurance were more likely to be sedated, whereas older patients and African American patients were less likely to be sedated.
Uspal et al, Hosp Pediatr, 2015
A retrospective study of febrile infants under 3 months of aguish fever of unknown source assessed the test characteristics of labs. Of the 318 patients 11 (3.5%) had bacteremia and 76 (24%) had UTI. The areas under the curve for invasive bacterial infection were:
- Procalcitonin, 0.77 (95% CI, 0.57-0.96)
- CRP, 0.54 (95% CI, 0.36-0.73)
- ANC, 0.53 (95% CI, 0.34-0.71)
- WBC, 0.42 (0.24-0.61)
For serious bacterial infection:
- Procalcitonin, 0.66 (95% CI, 0.59-0.74)
- CRP, 0.68 (0.60-0.76)
- ANC, 0.64 (0.56-0.71)
- WBC, 0.66 (0.58-0.72)
Note that procalcitonin was better, but still missed almost 30% of IBI. All but one of the patients with IBI had at least one abnormal value.
Diaz et al, Pediatr Emerg Care, 2015
Check out my recent post on Procalcitonin here
Here’s a new concept (to me at least) Secondary Overtriage. Some trauma patients seen at outlying hospitals don’t need to be sent to trauma centers. It turns out that the following features in patients <15 years of age may not need to come to a trauma center as they will likely be discharged home without major procedures once arriving there:
- Injury severity score (ISS) less than 9
- No need for surgical procedure
- No need critical care admission
- Expected length of stay of less than 24 hours
Interesting, but the latter three are a bit difficult to predict, and tough to quantify given the heterogeneity of patient presentations.
Goldstein et al, J Pediatri Surg, 2015
A cross-sectional analysis of syncopal patients with syncope presenting to the ED was performed in an effort to see what predicts cardiac cause. Approximately 2% of the 3,445 patients had a cardiac cause. Very few – 3 (0.09%) had a previously undiagnosed cardiac cause of syncope (2 with SVT and 1 with myocarditis). For reasons unbeknownst to me they chose 100 matched controls total for these 3 cases and concluded that the test characteristics of select features were:
- Syncope with exercise 67% sensitive and 100% specific
- Syncope preceded by palpitations 100% sensitive and 98% specific
- Syncope without prodrome 67% sensitive and 70% specific
The presence of at least two features yielded a sensitivity of 100% and specificity of 100%. It turns out that cardiac causes of syncope are very rare – history can help you find the needle in the haystack.
