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Cricoid Pressure and Rapid Sequence Induction of Anesthesia
The use of cricoid pressure during rapid sequence induction of anesthesia remains controversial. In a double-blind, noninferiority randomized clinical trial of 3472 patients undergoing anesthesia with rapid sequence induction, Birenbaum and colleagues demonstrated that the incidence of pulmonary aspiration was rare (0.5%), and noninferiority to the sham procedure was not found. Other secondary end points were also not significant, except those suggesting increased difficulties in tracheal intubation.
Continuing Medical Education
System-Level Factors and Secondary Overtriage in Trauma
Secondary overtriage (SO) contributes considerably to the economic burden of patients with injuries, but the influence of the underlying trauma system design on SO appears not to have been evaluated. In a retrospective cohort study using statewide data of 34 494 patient records, Parikh and colleagues found that system-level factors, such as trauma center distribution and choice of destination by emergency medical service personnel, significantly increase the rate of SO. These findings suggest that developing better guidelines along with better training and education outreach may reduce SO.
Aspirin Use to Prevent Clots After Total Knee Arthroplasty
There is considerable debate regarding the use of aspirin as prophylaxis after total knee arthroplasty. In a cohort study of 41 537 patients undergoing knee arthroplasty, Hood and colleagues sought to determine if aspirin alone was inferior to other pharmacologic prophylaxis in preventing venous thromboembolism or other bleeding events. They found aspirin was noninferior to other anticoagulants for both thromboembolism and bleeding events.
Choice Experiment of Patient Preferences for Bariatric Surgery
Surgical options for weight loss vary widely in risks and benefits, and knowing the most crucial risks and benefits informs patient counseling and surgical innovation. Rozier and colleagues used a discrete-choice experiment with 815 adults considering surgery to quantify the relative importance of procedure characteristics. Participants identified out-of-pocket costs, expected weight loss, and resolution of medical conditions as most important.
Clinical Review & Education
Fragility Index in Trauma Trials and Optimal Patient Care
The Fragility Index measures the robustness of clinical trial results by determining the minimum number of participants whose status would need to change from an event to a nonevent required to turn a significant result into a nonsignificant result. Tignanelli and Napolitano identified that trauma trial results are fragile (median Fragility Index score, 3; ie, moving 3 events to the opposite treatment arm eliminated significance). The authors strongly recommend the routine reporting of Fragility Index scores and inclusion in clinical guidelines to assist clinicians in ascertaining whether guideline recommendations are robust.
Highlights. JAMA Surg. 2019;154(1):1. doi:10.1001/jamasurg.2018.3785
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