TY - JOUR T1 - Journal update monthly top five JF - Emergency Medicine Journal JO - Emerg Med J DO - 10.1136/emermed-2021-212273 SP - emermed-2021-212273 AU - Ffion Barham AU - Robert Hywel James AU - Christopher Humphries AU - Henry Shirreff AU - Stacey Webster AU - Felix Wood AU - Jason E Smith AU - Laura Cottey Y1 - 2022/01/07 UR - http://emj.bmj.com/content/early/2022/01/07/emermed-2021-212273.abstract N2 - 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.Topic: abdominal painRating: head turnerStandard 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 al1 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.Bottom lineThis 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.Topic: traumaRating: worth a peekCorrection of reversible coagulopathy is commonly undertaken before invasive procedures, but is in itself … ER -