Annals for Hospitalists - 15 May 2018
Authors: David H. Wesorick, Vineet Chopra
Journal: Annals of Internal Medicine (2018)

Web Exclusives15 May 2018Annals for Hospitalists - 15 May 2018FREEDavid H. Wesorick, MD* and Vineet Chopra, MD, MSc*David H. Wesorick, MD*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W, V.C.)Search for more papers by this author and Vineet Chopra, MD, MSc*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W, V.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AFHO201805150 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesGetting Past the “Black Box”—Opportunities for Hospitalists to Improve Postacute Care Transitions—Christine D. Jones, MD, MS, and Robert E. Burke, MD, MSFor many hospitalists, the care provided after hospital discharge in skilled-nursing facilities and home health care—collectively termed postacute care—represents a “black box.” In this month's Inpatient Notes, the authors explain how a better understanding of postacute care might help hospitalists improve the discharge transition.Highlights of Recent Articles From Annals of Internal MedicineIn the Clinic: Acute Colonic DiverticulitisAnn Intern Med. 2018;168:ITC65-ITC80. doi:10.7326/AITC201805010This recent In the Clinic article provides an evidence-based overview of the epidemiology, diagnosis, and treatment of acute colonic diverticulitis.Key points for hospitalists include:Factors supporting a diagnosis of diverticulitis include age older than 50 years, pain or tenderness in the left lower quadrant, exacerbation of pain with movement, absence of vomiting, temperature of 38.5° C or higher, history of diverticulitis, and C-reactive protein level of 50 mg/L or higher. Scoring nomograms using these features can be highly specific but generally lack sensitivity.Computed tomography scanning with intravenous and luminal contrast is the imaging test of choice for diagnosing diverticulitis, with sensitivity and specificity of 95% and 96%, respectively. Alternative imaging modalities include ultrasonography (operator dependent, lower sensitivity and specificity) and magnetic resonance (highly sensitive and specific).In the acute setting, a surgeon should be consulted in cases of larger abscesses (larger than 3 cm), peritonitis, severe symptoms, failure to improve with medical therapy, and when diverticulitis is accompanied by bowel obstruction or fistula.All patients with an incident episode of acute diverticulitis should be referred for colonoscopy 4 to 8 weeks after resolution of the acute illness to rule out other pathologic conditions, such as colon cancer or inflammatory bowel disease.Applicability of Publicly Reported Hospital Readmission Measures to Unreported Conditions and Other Patient PopulationsAnn Intern Med. 2018;168:631-639. Published 27 March 2018. doi:10.7326/M17-1492This cross-sectional study examined data from the Nationwide Readmissions Database in 2013 and 2014 to determine the 30-day excess readmission ratios for several conditions. The study compared these ratios for 3 groups: Medicare patients admitted for conditions with reported readmission rates (e.g., heart failure, myocardial infarction, and pneumonia), non-Medicare patients admitted with the same conditions, and Medicare patients admitted for other conditions. The results demonstrate that the within-hospital readmission rates for these groups do not correlate highly.Key points for hospitalists include:The authors conclude that the Medicare-reported readmission rates for patients admitted with heart failure, myocardial infarction, or pneumonia do not correspond closely with readmission rates in the other groups and may not be good surrogates for overall hospital quality, as related to readmissions.An accompanying editorial points out that the readmission rates for Medicare patients with these 3 conditions were never intended to represent the overall readmission performance of a given hospital, and that a hospital-wide readmission metric already exists (although currently not used to assess financial penalties) that may more accurately reflect the overall readmission performance of hospitals. The Latest Highlights From ACP Journal ClubAre corticosteroids beneficial for the treatment of community-acquired pneumonia (CAP)?Review: Adjunctive corticosteroids reduce mortality and clinical failure in adult inpatients with CAPAnn Intern Med. 2018;168:JC40. doi:10.7326/ACPJC-2018-168-8-040Review: Adjunctive corticosteroids do not reduce mortality or clinical failure in adult inpatients with CAPAnn Intern Med. 2018;168:JC41. doi:10.7326/ACPJC-2018-168-8-041These 2 meta-analyses examine randomized controlled trials (RCTs) comparing treatment with corticosteroids with placebo (or no treatment) in patients with CAP, and each arrives at slightly different conclusions. The first review included 13 RCTs (only 6 of which were low risk for bias), and the second included 6 RCTs (almost all of which were low risk for bias). Of interest, both of these reviews showed a reduction in hospital length of stay and various measures of morbidity with the adjunctive use of corticosteroids. The first article also demonstrated a mortality benefit for patients treated with corticosteroids, but it disappeared when studies at high risk for bias were removed from the analysis. Together, these articles support the use of corticosteroids for the treatment of CAP in immunocompetent adult patients, although neither is able to clarify the optimal drug, dose, or duration.Does thrombectomy improve outcomes in acute ischemic stroke when added to usual care at 6 to 16 hours after symptom onset?In perfusion imaging-selected acute ischemic stroke, thrombectomy at 6 to 16 hours improved functional outcomesAnn Intern Med. 2018;168:JC42. doi:10.7326/ACPJC-2018-168-8-042In this study, 182 patients with acute ischemic stroke with proximal middle cerebral artery or cervical or intracranial internal carotid artery occlusion were randomly assigned to either usual care or usual care plus endovascular thrombectomy. Patients were included if they showed potentially reversible ischemia on perfusion imaging and were within a window of 6 to 16 hours after symptom onset. Thrombectomy patients had lower modified Rankin scores and mortality rates and higher levels of functional independence than control patients.Sign up here to have Annals for Hospitalists delivered to your inbox each month. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W, V.C.)Disclosures:Drs. Wesorick and Chopra have disclosed no conflicts of interest. The forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.* The authors are co-first authors and contributed equally to the article. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists Inpatient Notes - Getting Past the “Black Box”—Opportunities for Hospitalists to Improve Postacute Care Transitions Christine D. Jones and Robert E. Burke Metrics 15 May 2018Volume 168, Issue 10Page: HO10KeywordsDiverticulitisHeart failureHospitalistsInpatientsIschemic strokeMedicareMortalityMyocardial infarctionPneumoniaSpecificity ePublished: 15 May 2018 Issue Published: 15 May 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.Loading ...