This week Dr. Allison Lainey provided us with an excellent overview of acute ischemic strokes, delving into the evidence behind our current practice with tissue plasminogen activator (tPA) and looking forward to the changes that are occurring with the introduction of endovascular therapy (EVT). I was certainly intrigued and with a recent claim of “the biggest thing ever to happen to neurology”, it will be interesting to watch our practice evolve in the emergency department.
Allison finished her presentation reminding the audience that although EVT is looking quite promising, we shouldn’t forget about the intervention with the best evidence for improving outcomes – rehabilitation on multidisciplinary, dedicated stroke units. Try to catch her before she heads to Peterborough as a staff to discuss her thoughts on the current state and future of stroke management!
To download a pdf of this infographic click here: June 16 Grand Rounds.
Critically Appraised Topic Project: Should we be using an age adjusted D-dimer in the emergency room to rule out pulmonary embolism?
Instead of staff rounds, Dr. Mike Mason presented his CAT project on the utility of an age adjusted D-dimer to rule out PE. He took us through a complete summary of the literature, concluding that age adjusted D-dimers increase specificity with a minimal and acceptable decline in sensitivity in low risk patients. According to Dr. Jeff Kline, adjusted D-dimers are ready for prime time!
Refer to the ADJUST-PE Study for more information, and a prospective validation study of this test. Mike reminded us all that regardless of the adjustment, D-dimer is only useful as a rule out test in patients with a low risk of PE in the first place.