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An important step forward
The findings by Milcent et al are an important step forward in managing very young febrile infants, which remains a vexing problem.
A vital next step is to find alternatives to culture-based testing of blood, urine, and CSF. Genomic technologies that reliably detect molecular signatures in small amounts of biologic samples may be one such alternative. They may offer the additional benefit of identifying the pathogen and the host’s response to the presence of the pathogen.
Dr Nathan Kuppermann is in the departments of emergency medicine and pediatrics at the University of California–Davis. Dr Prashant Mahajan is in the departments of pediatrics and emergency medicine at Children’s Hospital of Michigan and Wayne State University, Detroit. They have no relevant financial disclosures. They made these remarks in an editorial accompanying Dr Milcent’s report (Kuppermann N, Mahajan P. Role of serum procalcitonin in identifying young febrile infants with invasive bacterial infections: one step closer to the holy grail [published online ahead of print November 23, 2015]? JAMA Ped. doi:10.1001/jamapediatrics.2015.3267).
Out-of-hospital MI survival is best in the Midwest
BY BRUCE JANCIN
AT THE AHA SCIENTIFIC SESSIONS
Vitals Key clinical point: Substantial and as-yet unexplained regional differences in survival and total hospital charges following out-of-hospital cardiac arrest exist across the United States. Major finding: Mortality among adults hospitalized after experiencing out-of-hospital cardiac arrest was 14% lower in the Midwest than in the Northeast. Data source: A retrospective analysis of data from the Nationwide Inpatient Sample for 2002-2012 that included 155,592 adults with out-of-hospital cardiac arrest who survived to hospital admission. Disclosures: The presenter reported having no financial conflicts of interest. |
ORLANDO – Considerable regional variation exists across the United States in outcomes, including survival and hospital charges following out-of-hospital cardiac arrest, Dr Aiham Albaeni reported at the American Heart Association scientific sessions.1
He presented an analysis of 155,592 adults who survived at least until hospital admission following non-trauma-related out-of-hospital cardiac arrest (OHCA) during 2002-2012. The data came from the Agency for Healthcare Research and Quality’s Nationwide Inpatient Sample, the largest all-payer US inpatient database.
Mortality was lowest among patients whose OHCA occurred in the Midwest. Indeed, taking the Northeast region as the reference point in a multivariate analysis, the adjusted mortality risk was 14% lower in the Midwest and 9% lower in the South. There was no difference in survival rates between the West and Northeast in this analysis adjusted for age, gender, race, primary diagnosis, income, Charlson Comorbidity Index, primary payer, and hospital size and teaching status, reported Dr Albaeni of Johns Hopkins University, Baltimore, Maryland.
Total hospital charges for patients admitted following OHCA were far and away highest in the West, and this increased expenditure didn’t pay off in terms of a survival advantage. The Consumer Price Index–adjusted mean total hospital charges averaged $85,592 per patient in the West, $66,290 in the Northeast, $55,257 in the Midwest, and $54,878 in the South.
Outliers in terms of cost of care—that is, patients admitted with OHCA whose total hospital charges exceeded $109,000 per admission—were 85% more common in the West than the other three regions, he noted.
Hospital length of stay greater than 8 days occurred most often in the Northeast. These lengthier stays were 10% to 12% less common in the other regions.
The explanation for the marked regional differences observed in this study remains unknown.
“These findings call for more efforts to identify a high-quality model of excellence that standardizes health care delivery and improves quality of care in low-performing regions,” said Dr Albaeni.
He reported having no financial conflicts of interest regarding his study.
Modified Valsalva more than doubled conversion rate in supraventricular tachycardia
BY AMY KARON
FROM THE LANCET
Vitals Key clinical point: A modified version of the Valsalva maneuver, in which patients were immediately laid flat afterward with their legs passively raised, more than doubled the rate of conversion from acute supraventricular tachycardia to normal sinus rhythm as compared with the standard Valsalva maneuver. Major finding: The conversion rate was 43% for the modified Valsalva group and 17% for patients undergoing the standard maneuver (adjusted OR, 3.7; P < .0001). Data source: Multicenter, randomized, controlled, parallel-group trial of 428 patients presenting to emergency departments with acute SVT. Disclosures: The National Institute for Health Research funded the study. The investigators declared no competing interests. |
A modified version of the Valsalva maneuver more than doubled the rate of conversion from acute supraventricular tachycardia to normal sinus rhythm when compared with the standard maneuver, said authors of a randomized, controlled trial published in the Lancet.
In all, 93 of 214 (43%) emergency department patients with acute supraventricular tachycardia (SVT) achieved cardioversion a minute after treatment with the modified Valsalva maneuver, compared with 37 (17%) of patients treated with standard Valsalva (adjusted odds ratio, 3.7; 95% CI, 2.3-5.8; P < .0001), reported Dr Andrew Appelboam of Royal Devon and Exeter (England) Hospital NHS Foundation Trust and his associates.