Is it just me or have we lost our collective minds? A recent trial published in JAMA, by Freund et al (1), illustrates just how far our diagnostic psychosis has progressed. The authors conducted a crossover cluster–randomized non-inferiority trial examining a strategy utilizing the pulmonary embolism rule out criteria (PERC) rule to rule out pulmonary […]
EM Nerd-The Case of the Shadowy Spector
The shadow of the long-term sequelae of submassive pulmonary emboli has stalked the hearts and minds of Emergency Physicians. The use of thrombolytics to prevent these ramification has previously been supported primarily with surrogate data, physiological reasoning and communal anecdotal experience. Thrombolytics for submassive pulmonary emboli have failed to demonstrate an improvement in short-term mortality […]
EM Nerd-An Addendum to the Case of the Incidental Bystander Part II
Recently I wrote a post discussing overdiagnosis in the workup for pulmonary embolism (PE). In it we discussed a recently published paper, the RESPECT-ED trial. Shortly after posting I was contacted by the lead author, Dr. David Mountain, with a number of comments and concerns on how the trial was represented. I have included it […]
EM Nerd-The Case of the Incidental Bystander Part II
The existence of overdiagnosis in the pursuit of pulmonary embolism (PE) is undeniable. But the burden of clinically insignificant PEs diagnosed by our current hypersensitive, zero-miss culture is less apparent. The authors of a recent article ironically entitled RESPECT-ED, attempted to quantify the role in which overdiagnosis plays in the current incidence of PE. Recently […]
EM Nerd-The Case of the Incidental Bystander
It is quite uncommon that while reading the results of a clinical trial one feels the universal gasp of sorrow released from the hearts and minds of Emergency Physicians worldwide. Maybe it was my own personal anguish at the realization of the disastrous consequences the results of a recent trial published in the NEJM will […]