Top Research Articles of 2015

EMRA’s Research Committee is pleased to present the Top Research Articles of 2015.  EMRA Committees and Divisions selected the leading 2-3 journal articles in their field of interest.  We have provided a short “Bottom Line” summary of each, but you may find the full article through the link to PubMed (personal access required).

Special thanks to all the EMRA Committees and Divisions that participated!

 

CRITICAL CARE

Frat JP, et al. High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure. N Engl J Med. 2015;372(23):2185-2196.


Bottom Line: Multicenter study in which patients without hypercapnia who had acute hypoxemic respiratory failure were randomized to receive high-flow oxygen, standard face mask, or noninvasive positive-pressure ventilation. There were no differences in intubation rates between the three groups, but there was a significant difference in favor of high-flow oxygen in 90-day mortality.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/25981908

Holcomb JD, et al. Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a 1:1:2 Ratio and Mortality in Patients With Severe Trauma The PROPPR Randomized Clinical Trial. JAMA. 2015;313(5):471-482.

Bottom Line: Multisite, randomized clinical trial of 680 severely injured patients comparing administration of plasma, platelets, and red blood cells in a 1:1:1 ratio with a 1:1:2 ratio. There were no significant differences in mortality at 24 hours or at 30 days, although the trend favored the 1:1:1 ratio. More patients in the 1:1:1 group achieved hemostasis and fewer experienced death due to exsanguination by 24 hours. There were no significant differences in 23 prespecified complications, including ARDS, multiple organ failure, VTE, sepsis, and transfusion-related complications.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/25647203

Goyal M, et al. Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke. N Engl J Med. 2015;372(11):1019-1030.

Bottom Line: Rapid endovascular treatment in patients with acute ischemic stroke with a small infarct core, a proximal intracranial arterial occlusion, and moderate-to-good collateral circulation reduces mortality and results in more favorable modified Rankin scale at 90 days compared with tpa alone. The 22 center randomized trial was stopped early because of efficacy.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/25671798


EDUCATION

Roland D, Brazil V. Top 10 ways to reconcile social media and ‘traditional’ education in emergency care. Emerg Med J. 2015;32(10):819-822.

Bottom line: Social media has emerged as a significant new medium through which medical education is delivered. Rather than being in conflict with traditional epistemological models, social media can effectively complement these models. This article outlines 10 methods for reconciling the divide between the “old” and “new” learning modalities.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/26253148

Beeson MS, et al. Initial Validity Analysis of the Emergency Medicine Milestones. Acad Emerg Med. 2015; 22(7): 838–844.

Bottom line: EM Milestone performance ratings were obtained on 100% of EM residents (n = 5,805) from 162 residency programs in this observational study. EM Milestones demonstrated validity and reliability as an assessment instrument for competency acquisition, with a reliability of α = 0.96 within each year of training.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/26112031

Weizberg M, et al. What does remediation and probation status mean? A survey of emergency medicine residency program directors. Acad Emerg Med. 2015;22(1):113-116.

Bottom Line:  There is great variation among PDs in the both the management and definition of remediation and probation. An anonymous electronic survey distributed to EM PDs (50% response rate) revealed that between 81 and 86% of programs place an official letter into the resident’s file regarding formal remediation and probation, while only about 50% notify the GME office when a resident is placed on formal remediation.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/25565491


EMS

Nuemar R, et al. Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132[18 Suppl 2]:S315–S367.

Bottom Line: Comprehensive review of evidence-based recommendations for resuscitation, emergency cardiovascular care (ECC), and first aid. Key highlights: chest compression rate of 100-120 and depth of 5-6cm, vasopressin is out of the ACLS Algorithm, negative troponin at 3-6 hours (together with low risk stratification) can be used to predicts a <1% chance of 30 day MACE.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/26472989

Gates S, et al. Mechanical chest compression for out of hospital cardiac arrest: Systematic review and meta-analysis. Resuscitation, 2015;94:91–97.

Bottom Line: Five randomized trials were included in this meta-analysis. The results did not show an advantage to the use of mechanical chest compression devices compared to manual compressions for survival to discharge and good neurological outcome.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/26190673


INFORMATICS

Payne TH, et al. Report of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs. J Am Med Inform Assoc. 2015;22(5):1102-1110.

Bottom Line: There has been an increase use for electronic health records (EHR).  Despite the potential benefits for EHRs, including safety and quality of healthcare, ease of information accessibility, patient safety and efficacy, there are concerns that new technology may lead to new risks and unintended consequences.  In this article, the American Medical Informatics Association task force describes 5 core areas for improvement: simplify and speed document, refocus regulation, increase transparency and streamline certification, foster innovation, and person centered care deliver.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/26024883

Han D., et al. Trends in biomedical informatics: automated topic analysis of JAMIA articles. J Am Med Inform Assoc. 2015;22(6):1153-1163.

Bottom Line: Biomedical informatics research has been increasing and evolving in recent years.  This article compared trends in biomedical informatics topics using tensor (i.e. multidimensional arrays) to manual topic selection.  The most common cited topic were Natural Language Processing, Medical Record Systems, and Computerized.  Results from tensor automatic search method for topic trends were similar to manual search.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/26555018


PEDIATRIC EM

Moler FW, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. N Engl J Med. 2015;372(20):1898-1908.

Bottom Line:  Therapeutic hypothermia has been shown to decrease mortality in out-of-hospital cardiac arrest (OHCA) in adults; however, limited data exists pertaining to this intervention for the pediatric population.  This study randomized 295 children between 2 days and 18 years of age to hypothermia (33C) or normothermia (36.8C) after an OHCA and showed no difference in survival with good neurobehavioral outcome at 1 year.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/25913022

Damlapinar R, Arikan F, Sahin S, Dallar Y. Lactate level is more significant than carboxyhemoglobin level in determining prognosis of carbon monoxide intoxication of childhood. Pediatr Emerg Care. 2015; Jul 14. [epub ahead of print]

Bottom Line: Among pediatric patients with suspected carbon monoxide exposure, carboxyhemoglobin concentration on arrival to the ED may not be the best indicator of severe poisoning.  This study analyzed biomarkers of 288 pediatric patients hospitalized for carbon monoxide poisoning and determined that lactate levels, specifically above 3.85 mmol/L, were significantly associated with severe carbon monoxide poisoning.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/26181501

Gehrmann LP, et al. Pediatric Extracorporeal Membrane Oxygenation: An introduction for Emergency Medicine Physicians. J Emerg Med. 2015;49(4):552–560.

Bottom Line: Extracorporeal Membrane Oxygenation (ECMO) for pediatric patients is frequently used in the inpatient setting, but EM providers should be aware of its application in the ED.  This article reviews ECMO’s applications in the ED, including sepsis, hypothermia, cardiac arrest, and respiratory failure, as well as complications and indications for transport of patients to ECMO centers.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/25980372


SIMULATION

Couto T, et al. High-fidelity simulation versus case-based discussion for teaching medical students in Brazil about pediatric emergencies. Clinics (Sao Paulo). 2015;70(6):393–399.

Bottom Line:  Nonrandomized crossover design comparing high-fidelity simulation with case-based discussion for teaching medical students about pediatric emergencies. There were no significant differences in acquisition and retention of knowledge as assessed by a post-test and a knowledge retention test. However, simulation was superior in terms of student satisfaction.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/26106956

Siegel NA, et al. In Situ Medical Simulation Investigation of Emergency Department Procedural Sedation With Randomized Trial of Experimental Bedside Clinical Process Guidance Intervention. Simul Healthc. 2015;10(3):146–153.

Bottom Line: Assessment of emergency department procedural sedation performance and safety practices of senior-level emergency medicine residents through in situ simulation. Study sessions used 2 pilot-tested EDPS scenarios with critical action checklists, institutional forms, embedded probes, and situational awareness questionnaires. EM residents performed well in terms of medical knowledge and procedural skills to perform EDPS; however, they performed less well in areas of nontechnical skills such as safety planning, information exchange and situational awareness.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/25844702

Dempsey E, Pammi M, Ryan AC, Barrington KJ. Standardised formal resuscitation training programmes for reducing mortality and morbidity in newborn infants (Review). Cochrane Database System Rev. 2015;9. doi: 10.1002/14651858.CD009106.pub2.

Bottom Line: Cochrane review of literature on the efficacy of standardized formal neonatal resuscitation training (SFNRT) programs in reducing neonatal mortality and morbidity, and improving acquisition and retention of provider knowledge and skills. There were no randomized studies in the developed world. Results of community based randomized trials in the developing world suggest that SFNRT results in a reduction of early neonatal and 28-day mortality.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/26337958


WILDERNESS

Kasprzak Z, et al. Vitamin D, Iron Metabolism, and Diet in Alpinists During a 2-Week High-Altitude Climb. High Alt Med Biol. 2015;16(3):230-235.

Bottom Line:  The authors analyzed whether Vitamin D contributes to iron metabolism or immune modulation at altitude.  After evaluation of 9 subjects at altitude for 2 weeks, they found that iron and Vitamin D decreased over the 2-week period while there was a reciprocal change in WBC. They also noted that the climbers’ diets were suboptimal.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/26125641

Lissoway JB, et al. Novel application of chemical cold packs for treatment of exercise-induced hyperthermia: a randomized controlled trial. Wilderness Environ Med. 2015;26(2):173–179.

Bottom Line: The authors propose that applying cold packs to the glabrous (hairless) regions of the body, specifically the cheeks, palms and soles, may be more effective at cooling exercise-induced hyperthermic patients than the traditional application of cold packs to the neck, axilla and groin.  Using 10 adult, male subjects, the results showed a statistically significant decrease in body temperature at 5 minutes and a steeper decline in temperature over 30 minutes after placement of cold packs at the glabrous regions compared to the traditional cold pack application.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/25771030

Seo Y, et al. The Influence of Exercise on Cognitive Performance in Normobaric Hypoxia. High Alt Med Biol. 2015; 16(4):298-305.

Bottom Line: Exercise may help improve cognitive function at altitude.  In this study, 16 male subjects underwent cognitive testing in normoxic conditions, hypoxic conditions and then hypoxic conditions during exercise.  The results showed an increase in cognitive function scores and mean reaction time between the hypoxic conditions with exercise compared to the baseline hypoxia scores, thus providing evidence that exercise may help attenuate the decrease in cognitive function at altitude.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/26214045

Author information

Cara Bergamo, MD

Cara Bergamo, MD

Cara Bergamo is an emergency medicine resident at Denver Health and the 2015-16 vice-chair of the EMRA Research Committee.

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