The Pulse - January 2026

Greetings Readers! In this monthly edition, we examine 2 practice changing studies.

Which central line location is associated with a 0% infection rate?

Studies exploring this intervention and more were covered this month in Premium Pulse. For less than a cup of coffee each month, get access.

1. From PE to DVT: Double Duty for D-dimer

   D-dimers have been validated to rule out PE, but what about DVTs? In a large multinational prospective study of ED patients with suspected lower-extremity DVT and low to intermediate Wells scores, age-adjusted D-dimer cutoffs safely ruled out thrombosis. Using the age-adjusted threshold (>500 μg/L if <50 years; >age×10 μg/L if ≥50), one-third of patients tested negative, with a very low 3-month miss rate (0.3%). This approach excluded DVT in an additional 7% overall and markedly improved test yield in older adults—boosting negative results from 9% to 26% in those ≥75 years. The practical upside: fewer false positives, fewer ultrasounds, and fewer hallway debates. As always, patients with high pretest probability should skip the lab and go straight to imaging. Le Gal G et al. JAMA 2026 Jan.

   Study Type: Multicenter (27), multinational (European and Canadian) prospective management outcome study of 3205 patients presenting to ED with suspected DVT.

   Link 

2. Treat the Number or the Patient? Magnesium Edition 

   In a massive quasi-experimental ICU cohort (>170,000 patients; ~500,000 Mg measurements), giving IV magnesium for marginally low levels near hospital cutoffs (1.6–2.0 mg/dL) didn’t reduce arrhythmias, shock, or mortality within 24 hours. About one-third of patients received supplementation (mean 3.1 g), yet outcomes were essentially unchanged compared with no repletion. Results held even among patients with hypokalemia or recent tachyarrhythmias, undermining the reflex to “top off” magnesium by protocol alone. If anything, there was a nonsignificant signal toward more shock and death with supplementation—hardly a selling point. Bottom line: routine Mg repletion at these levels in ICU patients appears unnecessary, with likely exceptions for ACS or postcardiac surgery where prior evidence suggests benefit. Goulden R et al. JAMA Int Med 2025 Dec.

   Study Type: multi center (93), multinational (US and European) non-randomized clinical trial of 171,727 ICU patients.

   Link

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