It has been a few years since tranexamic acid first rose to prominence in contemporary medicine following its popularization in bleeding trauma patients. This antifibrinolytic is inexpensive, is readily available, and does not appear to be associated with substantial adverse effects when administered promptly. This trial considered its use in women with postpartum hemorrhage, primarily in low-resource settings in Africa. There is a tiny mortality advantage associated with its use, but it is worth noting most women enrolled were very anemic at baseline and lacked modern supportive medical care.
Explore This IssueACEP Now: Vol 36 – No 11 – November 2017
Idarucizumab for Dabigatran Reversal–Full Cohort Analysis5
Good news! The full publication has finally arrived reporting outcomes for the entire planned cohort of patients in a trial reversing dabigatran-related bleeding with idarucizumab. Bad news! Lacking a control arm for comparison, there is minimal clinically useful information, and the sample size is small enough to obscure any reliable safety information. Idarucizumab is still probably clinically useful, but it should likely not be utilized unless all alternative supportive care options have been exhausted.
Randomized Trial of Icatibant for Angiotensin-Converting Enzyme Inhibitor-Induced Upper Airway Angioedema6
Angioedema induced by angiotensin-converting enzyme inhibitor (ACE-I) and other idiopathic upper airway angioedema remains a clinically challenging scenario in the emergency department. Many anecdotal and smaller studies have suggested the bradykinin ß2 receptor antagonist icatibant could expedite symptom resolution. Unfortunately, this larger, multicenter trial failed to find a benefit in routine use.
Accuracy of PECARN, CATCH, and CHALICE Head Injury Decision Rules in Children: A Prospective Cohort Study7
Around the world, different pediatric societies utilize different decision instruments to risk-stratify children with minor head injury. This prospective study applied the three major clinically validated rules against one another in a head-to-head comparison. PECARN was found to be the most sensitive, while CHALICE and CATCH reduced imaging to a greater extent. The real winner, however, was routine practice in Australia and New Zealand, where only 10 percent of children underwent CT compared with the 46 percent who would have had a CT if PECARN recommendations had been followed.
Effect of Abdominal Ultrasound on Clinical Care, Outcomes, and Resource Use Among Children with Blunt Torso Trauma: A Randomized Clinical Trial8
It’s been known for quite some time the utility of the abdominal focused assessment with sonography for trauma (FAST) is primarily in the unstable patient. This clinical trial evaluated the utility of FAST in children who were clinically stable. As expected, FAST in a stable patient did not change any measured outcomes, and the ultrasound examinations resulted in both substantial false positives and false negatives. Routine ultrasound should not be considered part of the standard clinical approach to the stable pediatric trauma patient.