Validation of the ABCD2 Score for Predicting Stroke Risk After Transient Ischemic Attack Key point: An ABCD2 score > 2 is associated with significantly increased risk for stroke within 90 days. Citation: Tsivgoulis G, Stamboulis E, Sharma VK, et al. Multicenter external validation of the ABCD2 score in triaging TIA patients. Neurology. 2010; 74(17): 1351-1357. The ABCD2 score has been endorse internationally as a simple method for identifying patients with transient ischemic attack (TIA) who …
Read MoreAbstracts in Urgent Care: June, 2010
Upper Gastrointestinal Tract Hemorrhage, Warfarin, and Urinary Tract Antibiotics Key point: Ciprofloxacin increased GI hemorrhage while on coumadin by twice as much, and cotrimoxazole by four times. Citation: Fischer HD, Juurlink DN, Mamdani MM, et al. Hemorrhage during warfarin therapy associated with cotrimoxazole and other urinary tract anti-infective agents: A population-based study. Arch Intern Med. 2010; 170(7): 617-621. Hemorrhage is a well-known side effect of long-term warfarin use in older patients. Interactions between warfarin and …
Read MoreAbstracts in Urgent Care: May, 2010
Emergency treatment of Anaphylactic Reactions Key point: Early treatment with intramuscular adrenaline is the treatment of choice for patients having an anaphylactic reaction. Citation: Pumphrey R, Cant A, Clarke S, et al. Emergency treatment of anaphylactic reactions – Guidelines for healthcare providers. Resuscitation. 2008; 77(2): 157-169. Patients experiencing an anaphylactic reaction have life-threatening airway and/or breathing and/or circulation problems usually associated with skin or mucosal changes. Such patients should be treated using the ABCDE …
Read MoreAbstracts in Urgent Care: April, 2010
Diagnostic Medical Errors: What Goes Wrong and Why Key point: Errors often occur because clinicians don’t consider the diagnosis, test for it, or follow up on abnormal test results. Citation: Schiff GD, Hasan O, Kim S, et al. Diagnostic error in medicine: Analysis of 583 physician-reported errors. Arch Intern Med. 2009; 169: 1881-1887. Autopsy data from the past few decades reveal diagnostic error rates of 10% to 15%, but do not inform us about the …
Read MoreAbstracts in Urgent Care: March, 2010
Consequences of Increasing Copayments for Ambulatory Care Key point: Even small increases in cost-sharing were associated with fewer outpatient visits and more inpatient admissions among elders. Citation: Trivedi AN, Moloo H, Mor V. Increased ambulatory care copayments and hospitalizations among the elderly. N Engl J Med. 2010; 62: 320-328. Recently, many health plans have increased copayments for outpatient visits. Although the rationale, presumably, is to minimize unnecessary ambulatory care, the strategy could backfire if higher …
Read MoreAbstracts in Urgent Care: February, 2010
Management of Forearm Fractures in Adults Key point: Primary care evaluation and management of forearm fracture in adults is presented. Citation: Black WS, Becker JA. Common forearm fractures in adults. Am Fam Physician. 2009; 15: 80(10): 1096-1102. Upper extremity fractures are often evaluated by primary care physicians at the patient’s initial presentation or at follow-up after the initial presentation to urgent care or the emergency department. These fractures account for approximately 2 million visits to …
Read MoreAbstracts in Urgent Care: January, 2010
CAP Treatment Recommendations: Guided in the Right Direction Key point: Results of two large cohort studies indicate that adherence to guidelines for treating community-acquired pneumonia is a good thing. Citations: Arnold FW, LaJoie S, Brock GN, et al. Improving outcomes in elderly patients with community-acquired pneumonia by adhering to national guidelines: Community-Acquired Pneumonia Organization International Cohort Study results. Arch InternMed. 2009;169:1515-1524. McCabe C, Kirchner C, Zhang H, et al. Guideline-concordant therapy and reduced mortality and …
Read MoreAbstracts in Urgent Care: December, 2009
Clinical Predictors of Pneumonia Among Children with Wheezing Key point: The routine use of chest radiography for children with wheezing but without fever should be discouraged. Citation: Mathews B, Shah S, Cleveland RH, et al. Clinical predictors of pneumonia among children with wheezing. Pediatrics. 2009; 124(1): e29-e36. A prospective cohort study was performed with children < 21 year of age who were evaluated in the ED, were found to have wheezing on examination, and had …
Read MoreAbstracts – November 2009
Cost and Quality of Care at Retail Clinics Key point: Quality scores at retail clinics rivaled those at urgent care centers, physician offices, and EDs. Citation: Mehrotra A, Liu H, Adams JL, et al. Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses. Ann Intern Med. 2009; 151(5): 321-328. Professional organizations have raised concerns about the quality of care that is delivered at store-based retail …
Read MoreAbstracts in Urgent Care: October, 2009
Another Validation of Clinical Assessment and D-Dimer to Rule Out PE Key point: Among patients with low or intermediate risk, the sensitivity and negative predictive value of D-dimer testing were 100%. Citation: Gupta RT, Kakarla RK, Kirshenbaum KJ, et al. D-dimers and efficacy of clinical risk estimation algorithms: Sensitivity in evaluation of acute pulmonary embolism. AJR Am J Roentgenol. 2009; 193: 425-430. Despite research showing that clinically important pulmonary embolism (PE) can be excluded when …
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