David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
In most patients older than 50 years with suspected PE, an age-adjusted cutoff for d-dimer should be used with the Wells rule to exclude the diagnosis.
An age-adjusted d-dimer cutoff seems to be safe across a wide range of subgroups (including patients with chronic obstructive pulmonary disease, cancer, venous thrombosis, and age older than 75 years).
In hospitalized patients, the age-adjusted d-dimer cutoff was associated with a modest 2.6% increase in the number of patients who could be ruled out for PE. Therefore, the efficiency of this approach for inpatients may be somewhat limited.
In 2008, CMS mandated public reporting of 30-day mortality rates for certain conditions, expecting that this would incite hospitals to take action to improve their rates. However, data provide no evidence that public reporting has led to improved outcomes.
The method of public reporting used by the Hospital Compare program may not sufficiently distinguish high- from low-performing hospitals. Consequently, the public may not consider these rates when choosing a hospital. Therefore, this type of public reporting may not offer a strong impetus for hospitals to improve in these areas.
Although the public availability of important hospital statistics should help patients make informed choices, public reporting alone may not drive significant improvements in outcomes, and other approaches to motivate improvement are needed.
Although no mosquito-borne transmission of Zika virus has yet been documented in the continental United States, numerous travel-associated cases have been reported.
Zika virus infection can be transmitted via a number of routes, including mosquito bites, sexual contact, perinatal routes, and possibly via blood transfusion.
Although most infections are asymptomatic, symptoms are typically nonspecific and include fever, pruritus rash, headache, and arthralgia.
There is growing concern about the association of Zika virus infection with adverse fetal outcomes (including microcephaly, intrauterine growth restriction, and fetal death) and the Guillain-Barré syndrome (GBS).
Hospitalists should obtain relevant travel history in patients presenting with viral prodromal symptoms, especially women who are pregnant or of child-bearing age, or patients exhibiting symptoms suggestive of GBS.
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David H. Wesorick, Vineet Chopra. Annals for Hospitalists - 16 August 2016. Ann Intern Med. 2016;165:HO1. doi: 10.7326/AFHO201608160
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Published: Ann Intern Med. 2016;165(4):HO1.
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