Sometimes it’s NOT just a sore throat – adolescents and young adults are different

Written by Dr. Robert Centor, creator of the Centor Score. Twitter: @medrants

In medical school we spend little time learning Pharyngalgiaabout sore throats. After all, it’s just a sore throat.

Group A beta-hemolytic streptococcal (GAS) tonsillitis dominates our sore throat concern, because it can cause acute rheumatic fever and peritonsillar abscess. We have rapid antigen tests for GAS so that we can treat patients with that infection. Continue reading “Sometimes it’s NOT just a sore throat – adolescents and young adults are different”

“Doc, do I really need this operation? What are the TRUE risks?” Improving the conversation around surgical risk using evidence-based medicine

A 70-year-old woman with peptic ulcer disease comes to the ED with sudden severe abdominal pain. She also has a history of diabetes and hypertension, both well controlled with oral medication. Her vitals at triage show low-grade tachycardia but are otherwise within normal limits. She is peritoneal on exam and an upright chest x-ray reveals free air. While labs are pending, she is made NPO and started on IV fluid resuscitation.

You are the general surgeon called to see the patient, and your history and Continue reading ““Doc, do I really need this operation? What are the TRUE risks?” Improving the conversation around surgical risk using evidence-based medicine”

Don’t Forget the Zebras: Familial Hypercholesterolemia

Did you know that FH is very treatable but missed in 90% of cases, and leads to early cardiac death? We’ve added some calculators to try to address it:

Unless you’re an endocrinologist, FH is one of those diseases you probably memorized in medical school, brought up on rounds when the Continue reading “Don’t Forget the Zebras: Familial Hypercholesterolemia”

About the ASCVD and ACC/AHA 2013 Calculators

With the launch of the ASCVD Calculator and the ASCVD algorithm we recently added to MDCalc (The difference? I’ll explain further down) we thought it might be nice to review the 2013 guideline. Let’s start at the beginning.

Before the ASCVD

A long time ago, in a galaxy far, far away, (2002) there were the ATP-III Guidelines — short for the “Adult Treatment Panel,” a group of cholesterol and lipid experts that attempted to figure out what the heck to do with patients with lipid issues. It really focused on LDL cholesterol and addressed trying to aggressively reduce it. Find high risk people with high LDL, and get that LDL down! Continue reading “About the ASCVD and ACC/AHA 2013 Calculators”

Discover: the qSOFA Score for Sepsis!

9515829903_9494aaa5f8_mBy now, hopefully you’ve heard that new sepsis definitions and criteria were released last month, and we wanted to take a moment to give a little deeper of a dive on one of the big new additions: quickSOFA (qSOFA).

Wait, why did sepsis get re-defined?

If you recall, we’d been using the SIRS Criteria and Sepsis definitions for many years, Continue reading “Discover: the qSOFA Score for Sepsis!”

Discover the Acute Gout Diagnosis Rule!

As part of our mission to help physicians discover new calculators that may help them in their practice (and potentially reduce unnecessary testing and provide better, more evidence-based, efficient and safer care to patients) we’re starting a new series to update physicians about new calculators added to the site that they may not be aware of.

First up, a disease that is near and dear to many physicians’ joints: gout!

TL;DR: The Acute Gout Score is a validated decision instrument that aims to reduce unnecessary testing for gout (we’re talking joint aspiration), encourage appropriate testing, and prevent other critical arthritis diagnoses from being missed. That’s pretty much everything you want from a score like this.

The Background and Goals: Gout is often diagnosed clinically by physicians, so researchers wanted to know — how good are physicians at this? They also wanted to see if they could improve this diagnosis and help risk stratify patients into high risk groups that could be safely started on gout treatment, medium risk groups that would benefit the most from joint aspiration (which is often painful, and does carry some risk), and low risk groups where it’s probably not gout and other causes of joint pain should be explored.

gout photo The Study: They took patients with monoarthritis and asked them a bunch of questions, examined them, took blood work, and then tapped everyone’s painful joint (the gold standard) and then looked to see which criteria predicted gout. They also asked physicians to predict which patients had gout, to see how good physicians are compared to the score.

The Results: The variables in the score were obviously the most associated with gout, with a high serum uric acid level being the most predictive, followed by the affected joint being the big toe’s metatarsophalangeal. (Tophus prescence was actually the most predictive — 100% — but was a pretty uncommon finding (12.9%).)

So they pulled out tophus (figuratively; that would hurt otherwise), and then ran a bunch of statistical analyses, and found that the rule was very good, with an AUC of 0.85 if you used labs, and 0.82 if you didn’t have lab results.

This score then got validated in another (ethnically similar) population. Gout was very likely in patients with a score of ≥8 (80% of these patients had gout), and was very unlikely in patients with a score ≤4 (only 2.8%). (The score did better than these family physicians, by the way.)

Our Take: If you’re sure it’s gout, you’re probably right. But if you have any concerns or thoughts that it might not be, or something isn’t totally fitting, try this score. It can help you figure out who you should probably tap or at least follow closely if they’re not improving or worsening — and in which patients you should broaden your differential, because it probably isn’t gout at all.