Literature review in hospital medicine

Each year at Bob Wachter's UCSF Hospital Medicine Course the last session is devoted to a run down of what the speakers felt were the most important research articles for the year. I was unable to attend this year but highlights of that talk were provided in a recent issue of Today's Hospitalist. Here's what I found interesting:

Up to 25% of patients admitted to the hospital with COPD exacerbation have acute PE. This prevalence equates to something between an intermediate and high risk Wells score even though by definition (“admission for COPD exacerbation”) such patients are lacking one of the two most heavily weighted Wells criteria (patient lacks a more likely cause of dyspnea). In related posts I noted that PE was the second most common cause of death in patients hospitalized with COPD and cited the meta-analysis referenced in the talk and one other paper.

10% of patients with unprovoked VTE will have a diagnosis of cancer within a year (paper here). The evidence, according to the speakers, does not support total body CT scans on all those folks, but thorough physical and standard laboratory examination as well as making sure standard screening recommendations are followed would be appropriate. When patients ask “what caused this blood clot” discussions often center on hereditary thrombophilia. How often do we advise patients of the increased cancer risk?

A five day antibiotic course may be all that's needed in most COPD exacerbations (paper here). Don't omit antibiotics, though, just because the patient doesn't have pneumonia, as there is evidence that antibiotics decrease mortality for AECOPD.

Dose vancomycin by actual body weight in obese patients, according to newly released IDSA guidelines for vancomycin use. (Earlier this year this consensus statement was released). Related post here.