Research Summaries
Procalcitonin-guided protocol superior to standard care for sepsis antibiotic duration
Using procalcitonin as a biomarker resulted in reduced total antibiotic duration in patients with sepsis compared with a C-reactive-protein-guided protocol and standard care, according to results of a U.K. randomized trial.
No neurologic benefit seen with liberal vs. restrictive transfusions in aneurysmal subarachnoid hemorrhage
A randomized clinical trial found that neurological outcomes at 12 months did not differ in critically ill patients with aneurysmal subarachnoid hemorrhage and anemia assigned to a liberal (mandatory at a hemoglobin level of 10 g/dL or lower) or restrictive (optional at a level of 8 g/dL or lower) transfusion strategy.
Expert clinical decision pathway details diagnosis, management of myocarditis
The guidance from the American College of Cardiology includes a five-step care pathway for myocarditis, including strategies for diagnosis, risk stratification, and surveillance, and proposes four new stages of disease classification.
Beta-lactam-first strategy linked with reduced mortality in sepsis patients
Giving beta-lactam therapy before vancomycin was associated with an 11% reduction in the odds of in-hospital death among patients with suspected sepsis, a review found.
Oseltamivir on day of admission associated with improved flu outcomes
A prospective, observational analysis of 840 influenza-positive patients in U.S. hospitals in the 2022 to 2023 season found that only about half got oseltamivir on the day of admission, and they had significantly lower risk of death or ICU admission than those who got the drug later or not at all.
As-needed blood pressure medication associated with acute kidney injury
Hypertensive patients who received as-needed blood pressure drugs, particularly IV ones, during a medical hospitalization had higher rates of acute kidney injury than those who didn't get as-needed meds, a retrospective Veterans Affairs study found.
AHA statement addresses management of systemic stroke complications
Fever, pneumonia, oral health problems, urinary tract infection, venous thromboembolism, breathing disorders, and gastrointestinal and renal issues were among the complications covered by new advice from the American Heart Association (AHA).
AGS advises on making treatment decisions for unrepresented older adults
A position statement from the American Geriatrics Society (AGS) includes policy recommendations and clinical advice for older patients who lack decisional capacity to provide informed consent for a specific medical treatment, who have no advance directive and lack capacity to create one, and who have no surrogate decision-maker.
Rapid correction of hyponatremia associated with lower mortality, review finds
Hospitalized patients with severe hyponatremia who had their serum sodium level corrected by 8 to 10 mEq/L per 24 hours or faster had significantly lower inpatient mortality than those who got slower correction, according to a systematic review of 16 studies.
Patients discharged to SNFs during early pandemic were older, more often from ICU
A single-center study compared Medicare discharges to skilled nursing facilities (SNFs) by age, concurrent depression diagnosis, length of stay, and ICU admission in March 2020 to February 2021, March 2021 to February 2022, and March 2022 to February 2023.
Observation stay patients more likely to return to hospital than admitted ones
Observation stays increased from 31.1% of Medicare hospitalizations shorter than five days in 2009 to 48.4% in 2019, according to a retrospective analysis of the top 30 most common conditions seen in observation units.
For BSI, seven days of antibiotics noninferior to 14 days, even in ICU patients
Ninety-day mortality was 14.5% among patients randomized to seven days of antibiotics for a bloodstream infection (BSI) compared to 16.1% in those assigned to 14 days of medication, a large international trial found.
Over one-third of surgical inpatients experience adverse events, study suggests
Nearly two in five patients who underwent surgery at one of 11 hospitals in Massachusetts in 2018 experienced adverse events, 60% of which were considered potentially preventable.
Outcomes similar with hospital-acquired COVID-19 vs. flu, Swiss study finds
A comparison of patients who developed symptomatic omicron-variant COVID-19 or flu during hospitalization found similar case-fatality rates at 6.2% and 6.1%, respectively. ICU admission was required for 2.4% of those with COVID-19 versus 2.6% with influenza.
Hospitalizations, liver transplants linked to alcohol on the rise across age, gender groups
Between 2005 and 2021, liver transplants associated with alcohol-induced liver disease saw a relative increase of more than 2,000% among women younger than 40 years of age in the U.S., and their liver disease hospitalization rate more than doubled, according to data from the National Inpatient Sample.
Heart failure admission outcomes similar with hospital at home, traditional inpatient stay
More than 90% of acute heart failure patients who were offered hospital at home care accepted it in place of a brick-and-mortar hospital stay, and 84% of them completed home hospitalization without requiring transfer back to the hospital, a retrospective analysis found.
Postop delirium risk, appropriate prevention strategy varies by surgery type
Older patients undergoing noncardiac surgery could be categorized into phenotypes that reflect their delirium risk and highlight potentially effective prevention strategies, from prehabilitation to proactive pain management, a retrospective study found.
Nearly half of deaths among patients hospitalized for flu occur postdischarge
Only 37% of patients who died within 30 days of discharge from an influenza hospitalization had flu listed as a cause of death and this was less likely the longer the time between hospitalization and death, indicating that the link may be underappreciated, according to a recent study.
Midline safe alternative to PICC for OPAT after discharge, retrospective study finds
In patients getting outpatient parenteral antimicrobial therapy (OPAT) for two weeks or less, major complication rates were lower with midline catheters than peripherally inserted central catheters (PICCs). For longer dwell times, complication and failure rates were similar between devices.
Functional impairments predict readmissions among older patients
Measures including hand grip strength, Short Physical Performance Battery scores, gait speed, low mobility, and the Timed Up-and-Go Test, used either before or during admission, identified those at higher risk for readmission within 90 days, according to a systematic review.
Personalized care recommendations for AKI response didn't improve outcomes
Individualized recommendations from a kidney action team did not reduce risk of acute kidney injury (AKI) progression, dialysis, or mortality among hospitalized patients who developed AKI, according to results of a randomized trial in seven U.S. hospitals.
New consensus guidance document advises on use of CGM in the hospital
A group of experts reviewed the potential benefits and barriers to continuous glucose monitoring (CGM) in the hospital, as well as summarizing existing guidance and discussing relevant staff training, clinical workflow, and hospital policies.
Low-risk patients can continue GLP-1 receptor agonists perioperatively, guideline says
Decision making about perioperative use of glucagon-like peptide-1 (GLP-1) receptor agonists should be collaborative and balance patients' metabolic need for the medication with their risk of delayed gastric emptying and aspiration, according to a new multisociety guideline.
Large-bore mechanical thrombectomy improves outcomes for intermediate-risk PE
Patients hospitalized with pulmonary embolism (PE) who received large-bore mechanical thrombectomy instead of catheter-directed thrombolysis were less likely to experience clinical deterioration and require subsequent ICU admission, an industry-funded randomized trial found.
Postsurgery recovery trajectories vary, even after 30 days, VA study finds
Factors including age, frailty, and type of operation could be used to better inform patients about how long it will be—from less than 30 days to never—before they are likely to return home after surgery, according to a study using a cohort from a Veterans Affairs (VA) database.
Neutrophil percentage key to identifying bacteremia in medical inpatients, study finds
The importance of white blood cell response, especially neutrophil percentage, to detecting bacteremia was shown by a retrospective study that calculated interval likelihood ratios for bacteremia based on a complete blood count with differential.
Many Medicare beneficiaries unable to afford out-of-pocket cost of single hospital stay
Between 34% and 50% of Medicare beneficiaries with incomes that are low, but above Medicaid eligibility, would be unable to cover the $1,600 out-of-pocket cost associated with a hospital stay, research shows.
Early anticoagulation noninferior to delayed after ischemic stroke in patients with afib
No difference in a composite outcome of recurrent ischemic stroke, symptomatic intracranial hemorrhage, unclassifiable stroke, or systemic embolism was seen between patients with atrial fibrillation who received anticoagulation four or fewer days after an ischemic stroke and those who received it between seven and 14 days after, a British trial found.
Handoffs led to identification of diagnostic errors in single-center study
Hospitalists who took over care from a physician going off service were surveyed about the diagnoses of handed-off patients; 18.2% of the patients had a diagnosis change, and in 5.8% of cases, there appeared to have been a diagnostic error.
Failure to rescue after high-risk surgery complication more common in female patients
Male and female patients had similar rates and types of serious complications after high-risk surgery in a cohort of over 860,000 Medicare beneficiaries, but female patients were more likely to die within 30 days of surgery.
Attendings vary widely in time spent in EHR, use it less while teaching
Hospital medicine attendings spent an average of 129 minutes per day in the electronic health record (EHR) while on a teaching service compared to 240 minutes while on a direct care service, but usage patterns varied widely from physician to physician, a single-center study found.
Albumin linked with worse outcomes in sepsis patients with kidney impairment
Patients with sepsis and kidney impairment who received albumin within 24 hours of admission were more than twice as likely to need renal replacement therapy compared with similar patients who did not receive albumin during hospitalization, according to a retrospective study.