Procalcitonin as a Predictor of Septic Knee Arthritis: A Retrospective Cohort Study.

INTRODUCTION: Differentiating septic arthritis from aseptic arthritis (AA) of the knee is difficult without arthrocentesis. Although procalcitonin (PCT) has shown diagnostic value in identifying bacterial infections, it has not been established as a reliable marker for identifying septic arthritis (SA). Recent studies have shown promise in the use of PCT as a useful systemic marker for identifying septic arthritis versus AA. This observational retrospective review compares PCT with routine inflammatory markers as a tool for differentiating septic arthritis versus AA in patients with acute, atraumatic knee pain. METHODS: Fifty-three consecutive patients (24 SA, 29 AA) were retrospectively reviewed at one institution with concern for SA. SA was diagnosed based on a physical examination, laboratory markers, and arthrocentesis. Laboratory indices were compared between the septic arthritis and AA groups. Data analysis was conducted to define sensitivity and specificity. Receiver operator characteristic curve analysis and regression were conducted to determine the best marker for acute SA of the knee. RESULTS: Using multiple logistic regression, bacteremia (OR 6.75 ± 5.75) was determined to be the greatest predictor of SA. On linear regression, concomitant bacteremia (coef 3.07 ± 0.87), SA (coef 2.18 ± 0.70), and the presence of pseudogout crystals (coef 1.80 ± 0.83) on microscopy predicted an increase in PCT. Using a PCT cutoff of 0.25 ng/mL yields a sensitivity of 91.7% and specificity of 55.2% for predicting SA; however, the ideal cutoff in our series was 0.32 ng/mL with a sensitivity of 79.2% and specificity of 72.4%. PCT was superior to the white blood cell count, erythrocyte sedimentation rate, and C-reactive protein in the area under the receiver-operating characteristic curve analysis. DISCUSSION: Procalcitonin seems to be the most sensitive and specific systemic marker in differentiating septic from AA.

Comparing outcomes between patients transferred from a critical access hospital versus directly from scene to a level 1 trauma center.

OBJECTIVES: The aim of this retrospective study was to compare the outcomes of trauma patients directly transported to a level I trauma center (SCENE) versus those who were stabilized at a critical access hospital (CAH) and subsequently transferred. METHODS: Patients were grouped based on their transfer status, interventions performed at CAH and outcomes. Google Maps was used to calculate the distances from the location of injury (LOI). Each transfer group data was analyzed separately to examine associations of different factors on the outcomes. Outcomes were compared using univariate and multivariate analyses and propensity score matching analysis. RESULTS: There were 262 patients in SCENE and 684 in CAH. Compared to SCENE, CAH had higher rates of blunt injury and a greater distance from LOI, whereas lower ISS score and length of stay (LOS) (p < 0.05). The majority of CAH group survived compared to SCENE (p = 0.007). For both groups, baseline factors (e.g., age) were associated with outcomes (p < 0.05). Interestingly, longer LOS in the CAH was associated with an increase in survival (p = 0.009), whereas an increased number of CT/MRI performed was associated with increased LOS (p < 0.05)., and an increased number of procedures was associated with longer LOS and ICU stay (p < 0.05). After matching, the two groups had no significant differences in survival, LOS, or ICU stay (p > 0.05). CONCLUSION: Equivalent overall clinical outcomes were seen in both groups, suggesting that existing trauma system protocols in the West Texas region are functioning well to select appropriate patients for each transfer modality. LEVEL OF EVIDENCE III: Retrospective Analysis.

Age-Adjusted D-Dimer in the Prediction of Pulmonary Embolism: Systematic Review and Meta-analysis.

BACKGROUND: Pulmonary embolism (PE), depending on the severity, carries a high mortality and morbidity. Proper evaluation, especially in patients with low probability for PE, is important to avoid unnecessary diagnostic testing. OBJECTIVE: To review the diagnostic utility of conventional versus age-adjusted D-dimer cutoff values in patients 50 years and older with suspected pulmonary embolism. METHODS: Systematic review with univariant and bivariant meta-analysis. DATA SOURCES: We searched PubMed, MEDLINE, and EBSCO for studies published before September 20th, 2020. We cross checked the reference list of relevant studies that compares conventional versus age-adjusted D-dimer cutoff values in patients with suspected pulmonary embolism. STUDY SELECTION: We included primary published studies that compared both conventional (500 µg/L) and age-adjusted (age × 10 µg/L) cutoff values in patients with non-high clinical probability for pulmonary embolism. RESULTS: Nine cohorts that included 47 720 patients with non-high clinical probability were included in the meta-analysis. Both Age-adjusted D-dimer and conventional D-dimer have high sensitivity. However, conventional D-dimer has higher false positive rate than age-adjusted D-dimer. CONCLUSION: Age-adjusted D-dimer cutoffs combined with low risk clinical probability assessment ruled out PE diagnosis in suspected patients with a decreased rate of false positive tests.