Emergency Medicine - News & Articles

Procalcitonin and CRP predict identify high-risk children with appendicitis

As published in Pediatric Emergency Care, procalcitonin and CRP levels discriminate between children admitted with a diagnosis of acute appendicitis who may require closer monitoring. The study involved 111 children who were divided into 2 groups based on intra-operative diagnoses of appendicitis (n=69) and peritonitis (n=42). Patients with peritonitis, who were more likely to have complications and require intensive care unit admission, had significantly higher procalcitonin (0.15 vs. 4.95 ng/ml) and CRP levels (3 vs. 14.3 mg/dl) on admission than patients with appendicitis. Using a cut-off procalcitonin level of 0.18 ng/ml, the sensitivity, specificity, positive predictive value, and negative predictive value for peritonitis were 97%, 80%, 72%, and 89.3%, respectively. Using a cut-off CRP level of 3 mg/dl, the sensitivity, specificity, positive predictive value, and negative predictive value for peritonitis were 95%, 74%, 68%, and 96.2%, respectively.

Vomiting during acute stroke increases mortality

As published in the Emergency Medicine Journal, patients who vomit during acute strokes have an increased risk of mortality (HR=5.06). Of 1968 stroke patients enrolled in the study, 1349 had cerebral infarctions, 459 had cerebral hemorrhages, and 152 had subarachnoid hemorrhages; 14.5% of all stroke patients vomited during the acute stage of the stroke (cerebral infarction, 8.7%; cerebral hemorrhage, 23.7%; and subarachnoid hemorrhage, 36.8%).

Association between tight glycemic control and hip fracture in diabetics

As published in the Journal of the American Geriatrics Society, patients with T2DM (mean age, 77.3 y; n=932) with a HbA1c < 6% (OR=3.01) or 6.1-7% (OR=2.34) are more likely to sustain a hip fracture than patients with a HbA1c > 8%. All patients had a HbA1c level determined within 3 months preceding the hip fracture. No differences in risk existed between patients treated with oral hypoglycemics or insulin.