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The Pulse - Special Edition: 2023 In Review
Keep your finger on it
Jonathan Kooiman
January 01, 2024
The pulse is a monthly, online newsletter summarizing key literature for the hospitalist. 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 special edition, we examine:
Top 10, practice-changing studies for hospitalists in 2023
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Should Patients with COPD Exacerbation Be Screened for VTE? When COPD flares up, maybe it's time to "vein-vestigate." A new study finds that one in four patients hospitalized for COPD exacerbations has a hidden VTE, raising the question: should we start scanning every breathless patient for clots? Our bar to screen will certainly be lower after reading this study. Liu X et al. Int J Chron Obstruct Pulmon Dis 2023 May.
Trial Type: large, prospective, multi-site Chinese study of nearly 1600 patients hospitalized for acute exacerbations of COPD
Hydrocortisone Decreases Mortality in Patients with Severe Community-Acquired Pneumonia. Hydrocortisone may just be the breath of fresh air severe pneumonia patients need! In a twist from previous studies (Meta analysis: NEJM JW Gen Med Apr 15 2023 and Chest 2023; 163:484), this trial shows that starting hydrocortisone early halves mortality rates, reduces the need for mechanical ventilation, and reduces shock. The reduction in mechanical ventilation was also noted in the above meta analysis. While earlier research left steroids on the sidelines, this new play hints they could be the MVP for patients battling severe community-acquired pneumonia, making guidelines reconsider when to call them in. (Dequin P-F et al. N Engl J Med 2023 Mar 21). This trial was followed by an Australian systematic review, meta-analysis encompassing 15 trials (in all, 3367 participants) which found lower mortality (P=0.001) in steroid group. Bergmann F et al. Clin Infect Dis 2023 Oct 25.
Trial Type: French randomized trial of 800 ICU with severe CAP
Link: https://doi.org/10.1056/NEJMoa2215145, https://doi.org/10.1093/cid/ciad496
Treating Alcohol Use Disorder at Time of Discharge. When it comes to treating alcohol use disorder (AUD) at hospital discharge, it seems most patients are left high and dry—less than 1% get medication to help stay sober. Hospitals are missing a prime opportunity to pour some medication into the mix for better outcomes. (Bernstein EY et al. Ann Intern Med 2023 Jun 27; Mayo-Smith MF and Lawrence D. Ann Intern Med 2023 Jun 27). A 2015 study showed that AUD patients receiving treatment upon discharge had lower readmission rates. J Gen Intern Med 2015; 30:365.
Trial Type: large retrospective study of 29,000 hospitalized Medicare beneficiaries with AUD
Link: https://doi.org/10.7326/M23-0641 , https://doi.org/10.7326/M23-1419
Antibiotic Duration for Moderate or Severe Acute Cholangitis. When it comes to treating acute cholangitis, this study suggests that when the drainage is on point, 4 days of post-drainage antibiotics is just as good as 8—proving that sometimes less really is more, and your gut (literally) may thank you for it! Srinu D et al. Am J Gastroenterol 2023 Oct 9.
Trial Type: unblinded, single-center, randomized trial of 120 patients with moderate to severe acute cholangitis in India
