Clinical

Short Takes


 

Non–private clinical encounters tied to diagnostic error and delays in delivery of care.

In a cross-sectional survey of 409 emergency physicians attending the American College of Emergency Physicians Scientific Assembly conference, a majority of respondents reported deviating from their standard history-taking and physical exam practices when practicing in a hallway location or when a patient had a companion present during the clinical encounter. Of those physicians who reported changing their practices during non–private clinical encounters, a significant proportion reported that these changes had led to a delay in patient care or diagnostic error.

Citation: Stoklosa H et al. Do EPs change their clinical behaviour in the hallway or when a companion is present? A cross-sectional survey. Emerg Med J. 2018 Feb 13. doi: 10.1136/emermed-2017-207119.

Retrospective case series of fluoroquinolone-induced acute interstitial nephritis (AIN).

A 23-year retrospective review of biopsy-proven cases of acute interstitial nephritis secondary to fluoroquinolones revealed that only 17% of cases presented with the typical triad of fever, rash, and eosinophilia, but that discontinuation of the offending agent resulted in complete or partial recovery in a majority of patients, with a median time to recovery of 20.5 days.

Citation: Farid S et al. Clinical manifestations and outcomes of fluoroquinolone-related acute interstitial nephritis. Mayo Clin Proc. 2018 Jan;93(1):25-31.

Trimethoprim associated with increased risk of AKI and hyperkalemia.

In a cohort study of older patients with urinary tract infections, trimethoprim was associated with increased risk of acute kidney injury and hyperkalemia, but not increased risk of death, in comparison to other antibiotics for UTIs. These risks were amplified for patients simultaneously taking renin-angiotensin system blockers or spironolactone.

Citation: Crellin E et al. Trimethoprim use for urinary tract infection and risk of adverse outcomes in older patients: cohort study. BMJ. 2018;360:k341.

Mortality of in-hospital cardiac arrest is decreasing, but disparities between on- and off-hours persist.

An analysis of 151,071 in-hospital cardiac arrests (IHCA) during 2000-2014 found that patient survival to hospital discharge increased from 13.6% to 22.0%, but return of spontaneous circulation, post-resuscitation survival, and overall survival to hospital discharge were all significantly lower for IHCA that occurred during nights or weekends, compared with weekday IHCA. The difference in on- and off-hours post-resuscitation survival rates did not significantly change over the 14-year study period.

Citation: Ofoma UR et al. Trends in survival after in-hospital cardiac arrest during nights and weekends. J Am Coll Cardiol. 2018;71(4):402-11.

Young women with acute myocardial infarction present differently than young men.

Interviews of 2,009 young women and 976 young men hospitalized for acute MI at U.S. hospitals revealed that, while both groups of patients reported chest pain as the predominant symptom, women were more likely to report a greater number of additional, non–chest pain symptoms.

Citation: Lichtman JH et al. Sex difference in the presentation and perception of symptoms among young patients with myocardial infarction. Circulation. 2018;137(8):781-90.

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