Brief Note: This article is a methods-only paper. The results of the Nexus study will be discussed in next week’s 52-in-52 Pearl. Article Citation: Hoffman JR, Wolfson AB, Todd K, Mower WR. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med. 1998 Oct;32(4):461-9. PMID: 9774931 What We […]

Pearl: When reading the antibiotic sensitivity chart for your patient’s current (or former) infection, you cannot use the MIC numerical values to compare antibiotics. Just stick to sensitive/resistant. Question: When you look up the antibiotic sensitivities for a patient’s cultured organism the table always lists MIC (minimum inhibitory concentration) ratio values (1:2, 1:8, 1:5) to the […]

Pearl: For patients with a true penicillin allergy, especially a Type I (IgE) reaction, increased cross-reactivity with first generation cephalosporins is real, but with third generation is not. Background: Some of us were taught a cross-reactivity rate between PCN allergies and cephalosporins as high as 10%. This appears to have emerged from a few low-quality […]

Pearl(s): If the nitrite and LE results are concordant (both + or both – ), the test is accurate ~90% of the time. Leuk esterase has a lower PPV (higher FP rate) than nitrites, especially in low prevalence populations and in the ER In general, nitrites have better PPV but lower NPV Give everyone a […]

Article Citation: McCullough PA, Nowak RM, McCord J, Hollander JE, et al. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation. 2002 Jul 23;106(4):416-22. PMID: 12135939 What we already know about the topic: BNP (Brain or B-type Natriuretic Peptide) is now routinely used to support the […]