sinaiem.org

The residency’s official website is now up! Kudos to Elaine for spearheading this, and to Phil and all the others who invested time on this project.

Check it out, give some feedback, and see if they used any pictures of you, your friends, or, say, Sridar Basavaraju.

Raakhee presents an abbreviated conference, consisting of a two-hour GI board review, this week at 10 AM in Hatch Auditorium.

Please use your extra free time wisely — to catch up on your New Innovations documentation and case files, and to read up on other board review topics and take the WebEd quizzes.

Please join us at Mount Sinai for our second Simulation Day of the year. Schedule TBA.

Please join us for Emergency Medicine Department Conference on Wednesday, October 22nd at 9AM in Mount Sinai’s Hatch Auditorium.

This week’s conference features two leaders in their field. At 9 AM we’ll hear NFL Medical Advisor and Director of Medical Services for the NY Jets, Dr. Elliot Pellman speak on playing field head and neck injuries. And at noon the Acting Deputy Chief Medical Officer for the Department of Homeland Security, Dr. Til Jolly, will speak on hospital and regional disaster plans.

The full schedule is below:

9am Grand Rounds: Dr. Eliot Pellman on “Football 101: On-Field Evaluation and Triage of Head and Neck Injuries”
10am Peds Core: Back Pain — Dr. Audrey Paul
11am Peds M&M — Dr. Daniel Singer
12pm EM Preparedness Lecture Series  — Dr. B. Tilman Jolly: “Disasters: Implications for Public Health”
1pm Trauma Board Review — Dr. Shawn Zhong

Lunch and breakfast will be served.

(Editor’s note: This Journal Club recap is brought to you by Seth, and covers the 10/1 journal club that Raakhee presented. The paper in question is Mongelluzzo J, et al. Corticosteroids and mortality in children with bacterial meningitis. JAMA 2008 May 7;299(17):2048-55. PMID: 1846066)

Corticosteroids have been shown to decrease mortality in the treatment of adults with bacterial meningitis — particularly pneumococcal meningitis — but the data on children are less clear. Although steroid therapy reduces hearing loss in Hib meningitis, vaccination has made Hib (and pneumococcus) much less prevalent in developed nations, and it is unclear whether steroids lower mortality in children with meningitis. This is the question a group of CHoP researchers set out to settle. However, much like the earlier literature, this paper failed to show any benefit from corticosteroid therapy.

The theoretical mechanism for steroid therapy is plausible enough — antibiotics lead to bacteriolysis, which leads to inflammation and cerebral edema. Corticosteroids control this response, but could also lead to decreased CSF penetration of antibiotics; GIB and other direct adverse effects could also result. Finally, there is the fear that steroids would mask a secondary fever if antibiotics failed.

The researchers’ methodology had its strengths and weaknesses. They used a retrospective cohort (children <18 years with bacterial meningitis), as a prospective double-blinded RCT would be difficult due to the relatively low prevalence of meningitis, and the risk associated with randomizing very sick children to treatment groups. The cohort was obtained from the Pediatric Health Information System (PHIS), a network of 27 tertiary care children’s hospitals in 18 states and DC, providing a strong multicenter patient and provider base.

However, study participants were identified through ICD-9 primary discharge code of meningitis, which can be problematic and was likely too narrow. It is conceivable that a large subset of meningitis patients are primarily coded as “fever,” “sepsis,” etc. Also, does this exclude patients who died during admission, a presumably important subset?

Furthermore, the while the usage of corticosteroids in adults has been shown to work, it is administered either 20 minutes prior to antibiotics, or with the first dose. The AAP’s current recommendation for children is similar, if the provider decides to give steroids.

However, in this paper, patients were given steroids at any point within the first 24 hours of hospitalization. As the authors used a fairly advanced statistical analysis (propensity scores), which required both a PhD and a very dense “Methods” section. The first analysis showed no difference when adjusted for propensity scores, except that the sickest patients were much more likely to have been given steroids, and the least sick were much less likely. Resultantly, they repeated the analysis, excluding the sickest and healthiest quintiles. The end result was again an insignificant difference, both in hospital length of stay and in mortality.

The main outcome measures: mortality rates of 6% (15/248) for the corticosteroid group, and 4% (102/2532); a relative risk of 1.5, but the confidence interval “crosses unity” (0.89-2.54). Very nice graphs also demonstrate that mortality and LOS follow essentially the same curves. Therefore, either there is no true difference in outcome, or the sample size (117 deaths among 2780 patients) was too small to demonstrate a difference.

Please join us this week for Emergency Medicine Departmental Conference, in the 8th floor conference room at Elmhurst Hospital.

The day’s activities are planned as follows:

8am Cardiology Conference — Dr. Lisa Jacobson
9am Board Review: ID — Dr. Jim Hinchey
10am Torture and Human Rights Abuse — Dr. Rajeev Bais
11am M+M — Dr. Amanda Holland
12pm HMED Update — Dr. Stuart Kessler

Lunch will be served. Please note the early start time.

Thanks to Grand Rounds speaker Dr. Gail D’Onofrio — her talk on rapid and effective alcohol use assessment and counseling for ED patients is online (many of this year’s Grand Rounds lectures are collected under the ‘conference’ tab).

Also thanks to Evelyn, whose Senior Lecture on US-guided regional anesthesia generated interest. Some of her links for futher information, anatomic diagrams, and sono screencaptures  are below:

Read More »

Please join us for Emergency Medicine Department Conference on Wednesday, October 8th at 9AM in Mount Sinai’s Hatch Auditorium.

Our featured speaker is Dr. Gail D’Onofrio, section chief of Yale’s EM division, who will be speaking on her research in alcohol management. We’ll also be joined by the chair of Neurosurgery, Dr. Joshua Bederson, who will be talking about the challenges facing his department and his specialty in general.

9am Grand Rounds: Alcohol Problems in the ED: Adding Pieces to the Puzzle — Dr. Gail D’Onofrio
10am Senior Lecture: Ultrasound-Guided Regional Anesthesia in the ED — Dr. Evelyn Chow
11am Visiting Chair Lecture Series  — Dr. Joshua Bederson
12pm M&M — Dr. Shefali Trivedi
1pm Board Review: Neurology — Dr. Nick Genes

Lunch will be served, as well as coffee and bagels in the morning.

Please join us on 10/1 for Emergency Medicine Departmental Conference, in the 8th floor conference room at Elmhurst Hospital.

The day’s planned activities are below:

8am Board Review — Dr. Nick Genes
9am Journal Club — Dr. Rakhee Mahajan
10am Research Lecture Series — Dr. Ula Hwang
11am Blunt Chest Trauma — Dr. Scott Weingart
12pm Toxicology Series — Dr. Ruben Olmedo

Lunch will be served. Please note the early start time.

Residents: The main journal club article for discussion is as follows:

Mongelluzzo J, et al. Corticosteroids and mortality in children with bacterial meningitis. JAMA. 2008 May 7;299(17):2048-55. PMID: 18460665

 Some background reading on steroids in meningitis is always advisable — please start with this brief recent review.