Annals of emergency medicine
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Multicenter Study
Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia.
The Pneumonia Severity Index and CURB-65 predict outcomes in community-acquired pneumonia but have limitations. Procalcitonin, a biomarker of bacterial infection, may provide prognostic information in community-acquired pneumonia. Our objective is to describe the pattern of procalcitonin in community-acquired pneumonia and determine whether procalcitonin provides prognostic information beyond the Pneumonia Severity Index and CURB-65. ⋯ Selective use of procalcitonin as an adjunct to existing rules may offer additional prognostic information in high-risk patients.
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Diabetic ketoacidosis is the most common cause of morbidity and mortality in children with type I diabetes mellitus, and cerebral edema is the leading cause of pediatric diabetic ketoacidosis death. Excessive intravenous fluid administration has been implicated as a cause of cerebral edema. We perform an evidence-based emergency medicine review assessing the association of intravenous fluid hydration and cerebral edema. ⋯ Accepting the inherent limitations of observational studies, we found a lack of strong or consistent results implicating rate or volume of fluid administration as a precipitant cause of cerebral edema in patients with diabetic ketoacidosis.
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Comparative Study
Comparison of two methods of pediatric resuscitation and critical care management.
We compare time to drug delivery and the incidence of dosage error between 2 different systems of medication administration: The Broselow Pediatric Emergency Tape and a standardized volume/weight-based dose reformulation of resuscitation and critical care medications (reformulated to 0.1 mL/kg). ⋯ Use of a standardized volume/weight-based dose reformulation method is a simple, fast, and accurate method of medication delivery for the pediatric patient that eliminates the need for memorization and/or calculation. The standardized volume/weight-based dose reformulation method performs better than the Broselow tape in speed of delivery of medications used for pediatric resuscitation and critical care without any reduction in dosing accuracy.
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WHAT IS ALREADY KNOWN ON THIS TOPIC: Procalcitonin is a biomarker that appears to correlate with bacterial infection. WHAT QUESTION THIS STUDY ADDRESSED: Does a procalcitonin level add prognostic information for pneumonia patients in conjunction with scoring systems such as the Pneumonia Severity Index or CURB-65? WHAT THIS STUDY ADDS TO OUR KNOWLEDGE: Among 1,651 patients with community-acquired pneumonia in 28 US emergency departments, procalcitonin levels did not add prognostic information for most pneumonia patients. ⋯ HOW THIS MIGHT CHANGE CLINICAL PRACTICE: Clinicians should continue using validated prognostic scoring systems for pneumonia. Low procalcitonin level could be considered as a factor for selected patients who would otherwise be considered high risk to be treated in a lower acuity setting.