Annals of emergency medicine
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Review Meta Analysis
Point-of-Care Ultrasonography for the Diagnosis of Skin and Soft Tissue Abscesses: A Systematic Review and Meta-analysis.
Skin and soft tissue infections are a common chief complaint in the emergency department. Research has shown that clinical examination alone can be unreliable in distinguishing between cellulitis and abscesses, a distinction that is important because they each require different treatments. Point-of-care ultrasonography has been increasingly studied as a tool to improve the diagnostic accuracy for these skin and soft tissue infections. The primary objective of this systematic review is to evaluate the diagnostic accuracy of point-of-care ultrasonography for abscesses. Subgroup analyses are performed for adult versus pediatric patients and high suspicion versus clinically unclear cases. Secondary objectives include the percentage of correct versus incorrect changes in management and reduction in treatment failures because of point-of-care ultrasonography. ⋯ According to the current data, point-of-care ultrasonography has good diagnostic accuracy for differentiating abscesses from cellulitis and led to a correct change in management in 10% of cases. Future studies should determine the ideal training and image acquisition protocols.
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Review Meta Analysis
Point-of-Care Ultrasonography for the Diagnosis of Skin and Soft Tissue Abscesses: A Systematic Review and Meta-analysis.
Skin and soft tissue infections are a common chief complaint in the emergency department. Research has shown that clinical examination alone can be unreliable in distinguishing between cellulitis and abscesses, a distinction that is important because they each require different treatments. Point-of-care ultrasonography has been increasingly studied as a tool to improve the diagnostic accuracy for these skin and soft tissue infections. The primary objective of this systematic review is to evaluate the diagnostic accuracy of point-of-care ultrasonography for abscesses. Subgroup analyses are performed for adult versus pediatric patients and high suspicion versus clinically unclear cases. Secondary objectives include the percentage of correct versus incorrect changes in management and reduction in treatment failures because of point-of-care ultrasonography. ⋯ According to the current data, point-of-care ultrasonography has good diagnostic accuracy for differentiating abscesses from cellulitis and led to a correct change in management in 10% of cases. Future studies should determine the ideal training and image acquisition protocols.
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We conduct a systematic review and Bayesian network meta-analysis to indirectly compare and rank antidysrhythmic drugs for pharmacologic cardioversion of recent-onset atrial fibrillation and atrial flutter in the emergency department (ED). ⋯ For pharmacologic cardioversion of recent-onset atrial fibrillation within a 4-hour ED visit, there is insufficient evidence to determine which treatment is superior. Several agents are associated with increased likelihood of conversion within 4 hours compared with placebo or control. Limited data preclude any recommendation for cardioversion of recent-onset atrial flutter. Further high-quality study is necessary.
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We conduct a systematic review and Bayesian network meta-analysis to indirectly compare and rank antidysrhythmic drugs for pharmacologic cardioversion of recent-onset atrial fibrillation and atrial flutter in the emergency department (ED). ⋯ For pharmacologic cardioversion of recent-onset atrial fibrillation within a 4-hour ED visit, there is insufficient evidence to determine which treatment is superior. Several agents are associated with increased likelihood of conversion within 4 hours compared with placebo or control. Limited data preclude any recommendation for cardioversion of recent-onset atrial flutter. Further high-quality study is necessary.
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The best initial strategy for nontension symptomatic spontaneous pneumothorax is unclear. We performed a systematic review and meta-analysis to identify the most efficacious, safe, and efficient initial intervention in adults with nontension spontaneous pneumothorax. ⋯ In the initial management of nontension spontaneous pneumothorax, the optimal strategy between the choices of a narrow-bore chest tube (<14 F, top ranked in efficacy) and needle aspiration (top ranked in safety) is unclear. Complications were more common in large-bore chest tube (≥14 F, including 14-F tube) insertions compared with needle aspiration.