Although the findings were consistent with results from prior analyses, the propensity-score adjustment used in the current study cannot fully account for all unmeasured confounding factors. The best way to compare catheter-directed thrombolysis and systemic thrombolysis for treating acute PE would be in a prospective, randomized study, Dr Saqib said.
Survivors of out-of-hospital cardiac arrest usually had intact brain function
BY AMY KARON
FROM THE AHA SCIENTIFIC SESSIONS
Vitals Key clinical point: Most adults who survived out-of-hospital cardiac arrests remained neurologically intact, regardless of duration of CPR in the field. Major finding: Only 12% of patients survived, but 84% of survivors had a cerebral performance category of 1 or 2, including 10% who underwent more than 35 minutes of CPR before reaching the hospital. Data source: A retrospective observational study of 3,814 adults who had an out-of-hospital cardiac arrest between 2005 and 2014. Disclosures: Dr Williams had no disclosures. The senior author disclosed research funding from the Medtronic Foundation. |
Most adults who survived out-of-hospital cardiac arrests remained neurologically intact, even if cardiopulmonary resuscitation lasted longer than has been recommended, authors of a retrospective observational study reported at the American Heart Association scientific sessions.
Dr Jefferson Williams of the Wake County Department of Emergency Medical Services in Raleigh, North Carolina, and his associates studied 3,814 adults who had a cardiac arrest outside the hospital between 2005 and 2014. Only 12% of patients survived, but 84% of survivors had a cerebral performance category of 1 or 2, including 10% who underwent more than 35 minutes of CPR before reaching the hospital.
Neurologically intact survival was associated with having an initial shockable rhythm, a bystander-witnessed arrest, and return of spontaneous circulation in the field rather than in the hospital. Age, basic airway management, and therapeutic hypothermia phase also predicted survival with intact brain function, but duration of CPR did not.
Procalcitonin assay detects invasive bacterial infection
BY MARY ANN MOON
FROM JAMA PEDIATRICS
Vitals Key clinical point: The procalcitonin assay was superior to three other tests at detecting invasive bacterial infection in febrile infants aged 7-91 days. Major finding: At a threshold of 0.3 ng/mL or more, procalcitonin level detected invasive bacterial infections with a sensitivity of 90%, a specificity of 78%, and a negative predictive value of 0.1. Data source: A multicenter prospective cohort study involving 2,047 infants treated at pediatric EDs in France during a 30-month period. Disclosures: The French Health Ministry funded the study. Dr Milcent and her associates reported having no financial disclosures. |
The procalcitonin assay was superior to C-reactive protein, neutrophil, and white blood cell measurements at identifying invasive bacterial infections in very young febrile infants, according to a study published in JAMA Pediatrics.1
Compared with other biomarker assays, procalcitonin assays allow earlier detection of certain infections in older children. A few small studies have hinted at the usefulness of procalcitonin assays in infants, but to date no large prospective studies have assessed these assays in the youngest infants. For this prospective study, researchers evaluated the diagnostic accuracy of procalcitonin and other biomarkers in a study of 2,047 febrile infants aged 7-91 days who presented to 15 pediatric emergency departments in France during a 30-month period.
“We did not include infants 6 days or younger because they are likely to have early-onset sepsis related to perinatal factors and because physiologic procalcitonin concentrations during the first [few] days of life are higher than thereafter,” said Dr Karen Milcent of Hôpital Antoine Béclère, Clamart (France), and her associates.
Serum samples were collected at the initial clinical examination, but procalcitonin assays were not performed at that time. Attending physicians diagnosed the infants as having either bacterial or nonbacterial infections without knowing the procalcitonin results. Then, procalcitonin tests were done retrospectively on frozen serum samples by lab personnel who were blinded to the infants’ clinical features. Thirteen (1.0%) infants had bacteremia and 8 (0.6%) had bacterial meningitis.
The procalcitonin assay was significantly more accurate at identifying invasive bacterial infections than was C-reactive protein level, absolute neutrophil count, or white blood cell count. At a threshold of 0.3 ng/mL or more, the procalcitonin level had a sensitivity of 90%, a specificity of 78%, and a negative predictive value of 0.1. In addition, the procalcitonin assay was the most accurate in a subgroup analysis restricted to patients whose fever duration was less than 6 hours and another subgroup analysis restricted to patients younger than 1 month of age, the researchers said.1
For young febrile infants, combining procalcitonin assay results with a careful case history, a thorough physical examination, and other appropriate testing offers the potential of avoiding lumbar punctures. These study findings “should encourage the development of decision-making rules that incorporate procalcitonin,” Dr Milcent and her associates said.