Friday, April 13, 2012

Early Steroids Probably Better for Asthma

Not sure if this is the study that proves it - since due to ethical considerations it's simply observational, and doesn't control for confounders and introduces a lot of bias - but, it's a small piece of the puzzle.

This is a cohort in a Montreal pediatric emergency department in which they prospectively collected data on moderate and severe asthma exacerbations as patients progressed through their care pathway.  They see, essentially, a nonsignificant trend in increased odds of hospital admission for patients in whom administration of systemic steroids was delayed.  This is mostly a data mining exercise, so any significant associations should be considered hypothesis generating.  However, considering the patients who received delayed steroids had milder exacerbations overall - yet still seemed to go on to have higher admission rates - it might be tempting to interpret these findings as appropriately confirmatory of physiologic foundations of treatment.

At least, there's no suggestion of harm from early steroid administration in asthma with exacerbation in children.  Perhaps some prospective interventional data with patient-oriented outcomes will surface in response.

"Early Administration of Systemic Corticosteroids Reduces Hospital Admission Rates for Children With Moderate and Severe Asthma Exacerbation"

Wednesday, April 11, 2012

ABCD2 For Cerebrovascular Dizziness

This is a bit of an interesting idea - a repurposing of the ABCD2 prediction instrument for TIAs as a risk-stratification instrument for cerebrovascular causes of "dizziness."

Every ED physician loves the complaint of "dizziness."  It's either giddiness, unsteadiness, lightheadedness, vertigo, and it's frequently difficult to elicit any pertinent neurologic symptoms to clarify one of the benign causes of vertigo or a cerebrovascular cause.

This is a retrospective chart review in which they evaluated the charts of 907 "dizzy patients", 37 of which had a cerebrovascular cause - 4.1%.  It's a small sample size - so the confidence intervals for their odds ratios are very wide - but for multivariable adjusted odds, age > 60 had an increased OR of 5.1, BP >140/90 had an increased OR of 2.9, speech disturbance had an OR of 6.2, and unilateral weakness had an OR of 10.9.  Essentially, it's interesting to see - and it makes sense - that the same features that generally portend stroke after TIA also might help predict which of your dizzy patients will be higher yield for a more intensive evaluation.

"Application of the ABCD2 Score to Identify Cerebrovascular Causes of Dizziness in the Emergency Department"

Monday, April 9, 2012

You Should Behave on the Internet

This is an interesting little research letter in JAMA regarding the incidence of state medical board review of unprofessional online behavior.  Of the 48 boards responding, 44 indicated that at least one complaint had been reviewed secondary to inappropriate online behavior.

The most commonly reviewed instances were inappropriate patient communication, online misrepresentation of credentials, and "inappropriate practice."  The most common responses noted by the survey were disciplinary proceedings, sanctions, and informal warnings - and half of medical boards reported license restriction, suspension, or revocation in response to proceedings.

Behave on the internet!

"Physician Violations of Online Professionalism and Disciplinary Actions: A National Survey of State Medical Boards"