Archive for November 2012

When can we send a PE home from the ED?

This systematic review found evidence from 7 trials that low risk patients with new acute symptomatic PE may be discharged home from the ED; of 741 patients discharged home, none died, 3 had major bleeding, and 13 had a recurrent PE. Some low risk patients can safety be discharged from the ED with acute symptomatic PE (abstract).

IV hydration not beneficial in end stage cancer

In this trial of 129 patients with end stage cancer, they were randomized to IV hydration (1 liter a day) or control (100 cc a day), and found no difference between the groups in symptoms of dehydration, delirium, or fatigue, and no difference in survival. This randomized trial does not support the use of IV hydration in patients with end stage cancer (abstract).

Type of catheter does not matter for CA-UTI reduction

In this large randomized controlled trial of hospitalized patients, those requiring short term indwelling urinary catheters were randomized to silver-alloy, antibiotic, or control catheter. The rate of symptomatic UTI was 13%, 11%, and 13% respectively, which was not significantly different between the groups. This randomized study does not support the routine use of silver or antibiotic-coated foley catheters for short term use in hospitalized patients (abstract).

Warfarin bleeding rates in “real world” Afib

This large observational study of ~125,000 patients on warfarin for Afib found the rate of bleeding to be ~4% per person-year (which is higher than rates reported in randomized controlled trials). Bleeding was highest in the first 30 days (12%), and much higher in the first 30 days in those with a CHADS2 score of 4+ (17%). In addition, over 5 years, 9% of patients were admitted for bleeding, and 18% of those died in the hospital, or within 7 days of discharge (abstract).