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This month’s update is from the Academic Department of Military Emergency Medicine and University Hospitals Plymouth NHS Trust. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlighted the main findings, key limitations and clinical bottom line for each paper.
The papers are ranked as:
Worth a peek—interesting, but not yet ready for prime time.
Head turner—new concepts.
Game changer—this paper could/should change practice.
Efficacy and safety of non-antibiotic outpatient treatment in mild acute diverticulitis (DINAMO study): a multicentre, randomised, open-label, non-inferiority trial by Mora-Lóez et al
Topic: abdominal pain
Rating: head turner
Standard practice for treatment of diverticulitis without abscess, poor pain control or other systemic symptoms is discharge with antibiotics. In this Spanish study, Mora-López et al 1 demonstrate that discharging patients with symptomatic management (ibuprofen and paracetamol) is not inferior to symptomatic treatment plus with co-amoxiclav. Their patient group (n=480) were adults under 80 years with no significant comorbidities and CT-confirmed mild diverticulitis (defined using a previously derived and published scoring system). Of note, the study excluded patients with angina in the last 3 months, chronic kidney disease or diabetes with end organ dysfunction.
No significant differences were found between the two groups in terms of re-attendance to ED, admission for uncontrolled symptoms, pain control or recovery at 90 days. Importantly, no participants required emergency surgery at any point in the study.
Implementation of this management framework would require all patients with suspected diverticulitis to have a CT scan to define severity before treatment decided, but this may be a useful tool to prevent overnight inpatient bed admissions.
This is another piece of evidence that could prevent unnecessary use of antibiotics and reduce harm from overtreatment, but should be interpreted with caution in very elderly patients or those with significant comorbidities.
Safety of thoracentesis and tube thoracostomy in patients with uncorrected coagulopathy: a systematic review and meta-analysis by Fong et al
Rating: worth a peek
Correction of reversible coagulopathy is commonly undertaken before invasive procedures, but is in itself …
Twitter @Rob209no, @lauracottey
Contributors All authors have contributed in line with the ICMJE guidelines.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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