Archive for April 2012

Choosing Wisely or Vicely

The press gave the Choosing Wisely initiative, unveiled several weeks ago, a great deal of attention.  Briefly, the ABIM foundation collaborated with Consumer Reports to produce Top 5 lists from nine specialty societies to identify "five tests or procedures commonly used in their field, whose necessity should be questioned and discussed."  It is a first step to engage patients and physicians in the shapeless "national conversation" on (sensibly) rationing that everyone speaks of, but never hears.  I write about it now, not just because this process is inevitable—which it is, but because the Society of Hospital Medicine is amongst the next group of eight to offer up recommendations. (more…)

Low CT as effective as high dose CT for appendicitis

There are >250,000 cases of appendicitis in the US annually, most of which are diagnosed by CT scan. This study compared the diagnostic accuracy of low dose versus high dose CT for diagnosing appendicitis, and found no difference between the 2 study types in rates of negative appendectomies (surrogate for false positives) or appendix perforation rates (surrogate for false negatives resulting in diagnostic delays). The amount of radiation exposure was only ~a quarter with low dose compared to high dose. Low dose CT should be considered for rule out appendicitis imaging, especially in centers with experienced radiologists (abstract)

Epidemiology and prognosis with device-related endocarditis

This large retrospective cohort found ~6% of endocarditis cases are associated with cardiac devices (the majority pacemakers), 2/3 of which are caused by staph. In hospital and 1 year mortality rates were 15% and 23%, and mortality was lower among those whose device was removed (hazard ratio 0.42, CI 0.22 to 0.82). (abstract)

VTE risk after knee arthoscopy

In this large retrospective analysis, the rate of VTE following knee arthroscopy was 0.4%; given the overall low risk, most patients will not require VTE prophylaxis, but it should be considered in those at high risk (e.g. prior VTE) (abstract)

Contemporary efficacy of warfarin for afib-related stroke prevention

As new antithrombotics become available, contemporary efficacy of warfarin to reduce afib-related stroke is needed to determine which agents are best for which patients. In this meta-analysis of 8 large RCTs, time spent in therapeutic range was 55% to 68%, and annual risk of stroke was 1.7% per year (higher with higher CHADS2 scores) and risk of bleeding ranged from 1.4% to 3.4% per year. The contemporary statistics can help physicians and patients make the best anticoagulation decisions for stroke prevention (abstract)