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- The Pulse - January 2025
The Pulse - January 2025
Keep your finger on it
Jonathan Kooiman
January 31, 2025
The pulse is a monthly online newsletter summarizing key literature curated for the hospitalist/inpatient provider. Given the brevity, this is not meant to supplant reading primary literature independently. If you think a conclusion is interesting, we recommend reading further.
In this monthly edition, we examine 3 practice changing studies from January 2025.
Shout out to Dr. Tanriverdi of SUNY Upstate Medical University, winner of the Referral Contest this past month. Scroll to bottom for more info for this month.
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Another Case of Treat the Patient, Not the Number
Prescribing PRN blood pressure medications for hospitalized patients with asymptomatic hypertension may do more harm than good, as this practice is linked to a higher risk of acute kidney injury, rapid BP drops, and adverse cardiac events. This study adds additional data to the recent Consensus Statement in Oct 2024 recommending against this practice. Canales MT et al. JAMA Intern Med 2025 Jan.
Study Type: retrospective cohort study of 133,000+ patients from VA hospitalizations; 96% male predominance in the study population raising generalization concerns
Shaving a Day Off Sepsis Antibiotics: Worth the Gamble?
Procalcitonin tracking can shave off a day of antibiotics for sepsis patients, but the slight uptick in mortality in that group raises eyebrows. Tracking CRP showed no benefit to antibiotic duration. While it may help curb antibiotic overuse, relying solely on biomarkers feels like flirting with uncertainty. Dark P et al. JAMA 2024 Dec 9.
Study Type: ADAPT-Sepsis is a multicenter, randomized trial of 2760 UK ICU-hospitalized patients with suspected sepsis. One third were randomized to the daily procalcitonin-guided protocol, 1/3 to daily CRP-guided protocol and 1/3 to standard of care.
EHR Sepsis Alerts: Life-Saving or C. Diff-Stirring?
The next time you get alerted for an elevated sepsis score for the patient already on antibiotics and diagnosed with pneumonia, you may want to take a deep breath… and remember this study. Sepsis alerts in the EHR, triggered by the qSOFA score, may have finally proven their worth—lowering 90-day inpatient mortality by 15% (adjusted). However, the trade-off: a potential uptick in C.diff. Bottom line: with proper training and feedback loops, EHR sepsis screening can save lives, but vigilance about unintended consequences is crucial. Arabi YM et al. JAMA 2024 Dec 10 Angus DC. JAMA 2024 Dec 10.
Study Type: stepped-wedge, cluster randomized trial of 5 hospitals in Saudi Arabia, randomizing 45 hospital wards (60,000+ patients) to 2 month periods of sepsis screening protocol