April 25, 2012
Volume 7 - Issue 17     

DynaMed Weekly Update

For the week ending April 20, 2012 

Last week 230 articles were evaluated via DynaMed's Systematic Literature Surveillance and 130 were added to DynaMed content.    


Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update. 
Feature Article

Use of CT Angiography in Low-Risk Patients with Suspected ACS Appears to Safely Increase Discharge from Emergency Department to Home


Patients with suspected acute coronary syndrome (ACS) are often admitted to the hospital after presentation at the emergency department (ED), but in most cases, their symptoms are eventually found to have non-cardiac causes. Various testing protocols to identify low-risk patients have attempted to decrease unnecessary hospital admissions. Multidetector computed tomography angiography (MDCTA) can be used to rule out significant coronary artery disease and may be able to rule out ACS in patients presenting with chest pain. A recent randomized trial of 1,392 low-risk patients with suspected ACS (mean age 49 years) evaluated whether use of MDCTA could safely increase the rate of patients discharged without hospital admission.


Patients with a Thrombolysis in Myocardial Infarction (TIMI) risk score 0-2 (0-7 scale), who had been determined by the treating physician to require either admission or objective testing to rule out ACS were randomized to MDCTA vs. standard care. Of 929 patients randomized to MDCTA, 767 had the scan, and 83% of those had a negative result defined as coronary artery stenosis < 50%.


The rate of discharge from ED to home was 49.6% for MDCTA vs. 22.7% for standard care (p < 0.05, NNT 4), and MDCTA was associated with significantly shorter median hospital stay (18 hours vs. 24.8 hours, p < 0.001). At 30-day follow-up, no patients in either group had died, and there were no significant differences in rates of acute myocardial infarction, revascularization or invasive angiography (level 2 [mid-level] evidence) (N Engl J Med 2012 Apr 12;366(15):1393). It should emphasized that the lower rates of hospitalization demonstrated here were based on comparison to "usual care" and not to other methods for rapid evaluation, such as stress testing, in the Emergency Department.


For more information, see the Acute coronary syndrome topic in DynaMed.


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DynaMed Event

Society of Teachers of Family Medicine (STFM) Conference 

Learn more about EBM and scholarly activity at seminars and education sessions at the STFM Annual Spring Conference April 25th through the 29th.

Saturday, April 28

S41: 10:30-12:00; Engaging Scholarly Activity: Electronic Peer Review of Evidence William Cayley Jr, MD; Brian Alper, MD, MSPH; Michael Mendoza, MD, MPH; Susan Hadley, MD

S43: 1:45-3:15; Using Electronic Knowledge Resources at the Point of Precepting William Cayley Jr, MD; Michael Mendoza, MD, MPH; Ingrid Watkins, MD; Mathew Devine, DO; Alexander Chessman, MD  

Call for Peer Reviewers

We are currently seeking reviewers for:

Kaposi sarcoma

Takotsubo cardiomyopathy

Upper extremity deep vein thrombosis


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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: April 25, 2012
Expiration Date: April 25, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
No commercial support has been received for this activity.

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ACCME This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians.  Antidote Education Company designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This Enduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each weekly update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.  

Program ID 1102072H.

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