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Journal update
Journal update monthly top five
  1. Christopher James Ambrose1,
  2. Catherine Williams1,
  3. Richard Parris1,
  4. Anukiran Ravichandran1,
  5. Anisa Jabeen Nasir Jafar2
  1. 1 Emergency Department, Bolton Hospitals NHS Trust, Bolton, BL4 0JR, UK
  2. 2 Humanitarian and Conflict Response Institute, The University of Manchester, Manchester, UK
  1. Correspondence to Dr Christopher James Ambrose, Royal Bolton Hospital NHS Foundation Trust, Bolton, UK; chris.ambrose{at}doctors.org.uk

https://doi.org/10.1136/emermed-2024-214162

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    This month’s update is by the Royal Bolton Hospital. 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 highlight 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.

    Point-of-care ultrasound associated with shorter length of stay than computed tomography for renal colic by Orosco et al

    Topic: point-of-care ultrasound (PoCUS)

    Outcome rating: worth a peek

    This retrospective cohort study of electronic medical records primarily compared the length of stay (LOS) in the ED between PoCUS and CT for diagnosing renal colic.1 Conducted in two US hospitals, the study enrolled patients ≥18 years with a final diagnosis of renal colic. 325 of 415 eligible patients were included: 46.2% underwent only CT, 24.6% underwent only PoCUS, 16.6% underwent both and 12.6% underwent neither. The overall mean LOS in the ED was 284 min. Patients receiving PoCUS alone experienced a median LOS of 231.5 min compared with 307 min for CT alone giving a median LOS difference of 75.0 (95% CI 39.3 to 110.7).

    There are limitations due to the study’s retrospective design, single region of the USA and small sample size. There are also potential confounding factors through boarding, ED throughput and the unknown impact of ‘workup bias’ where physicians may have selected patients for different diagnostic approaches based on clinical condition or gestalt, or whether they were credentialed or comfortable with renal PoCUS. However, the study only included patients on days where at least one PoCUS was performed, to reduce the impact of PoCUS availability on the results.

    Bottom line

    Incorporating PoCUS early in the evaluation of renal colic may reduce delays in treatment and hospital stay; however, prospective evaluation is needed.

    Rethinking cervical spine clearance in obtunded trauma patients: An updated systematic review and meta-analysis by Dion et al

    Topic: trauma …

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    Footnotes

    • X @sassyEMtrainee

    • Contributors All five summaries were written and edited by the contributing five authors, with final editing by the editor in chief.

    • 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.