Insights from Dr. Robert M. Centor, Creator of the Centor Score for Strep Pharyngitis

Antibiotic overuse and misuse is a growing public health concern, and foregoing the administration of antibiotics in cases where they are not needed can be a challenging decision to defend without good evidence to back it up. The Centor Score for Strep Pharyngitis is one of the most practical and useful evidence-based decision tools that helps support clinicians in making those decisions. We interviewed Dr. Robert Centor on developing and using the Centor Score.

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Why did you develop the Centor Score? Was there a clinical experience that inspired you to create this tool for clinicians?
In 1979, while working in the “non-acute” adult emergency room, a resident asked me how to evaluate a sore throat patient. Having just finished my residency, I started to give a definitive answer, but had a moment of humility and told him that I did not know. We made a treatment decision at the time, and I went to the library to learn more. Continue reading “Insights from Dr. Robert M. Centor, Creator of the Centor Score for Strep Pharyngitis”

Insights from Dr. Jeffrey Perry, Creator of the Ottawa Subarachnoid Hemorrhage Rule

Subarachnoid hemorrhage, if undiagnosed, can have devastating consequences. While headache is a common presenting complaint in emergency departments, only about 1% of these patients are diagnosed with SAH. The Ottawa SAH Rule helps rule out SAH with 100% sensitivity, to better identify which patients do and do not need further workup. We talked with Dr. Jeffrey Perry, first author of the Ottawa SAH Rule derivation study.

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Dr. Jeffrey J. Perry

How did you develop the Ottawa SAH Rule? Was there a particular patient or clinical experience you had?

Two things: One was the apparent subjectivity I noticed as a resident in evaluating patients for SAH, where the criteria for which patients we would investigate seemed to be very different. Some of the patients I thought were very low risk, other physicians would want to still investigate them for SAH, including doing a CT, which didn’t bother me too much, but then they would go on to do an LP, which is very uncomfortable, and time-consuming, and it seemed to contribute to already very prevalent ED overcrowding. So that was the clinical side of things. Continue reading “Insights from Dr. Jeffrey Perry, Creator of the Ottawa Subarachnoid Hemorrhage Rule”

Insights from Dr. Gregory Lip, Creator of the CHA2DS2-VASc Score

The CHA2DS2-Vasc Score is one of the most widely-used clinical risk scores for stroke. It’s arguably the best validated and is consistently in the top five most popular calcs on MDCalc. Professor Gregory Lip, the newest member of MDCalc’s Scientific Advisory Board, gave us an interview on developing and using the CHA₂DS₂-VASc Score.

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Dr. Gregory Lip

Why did you develop the CHA₂DS₂-VASc Score? Was there a clinical experience that inspired you to create this tool for clinicians?

The availability of Non-Vitamin K Antagonist Oral Anticoagulants (NOACs), previously referred to as new or novel oral anticoagulants, has led to a major change in the landscape for stroke prevention in atrial fibrillation (AF). Clinicians are also getting better at understanding how to manage warfarin, recognizing the importance of the average time in therapeutic range (TTR). New data are also re-emerging on the poor evidence for the efficacy and safety of aspirin for stroke prevention in AF. Continue reading “Insights from Dr. Gregory Lip, Creator of the CHA2DS2-VASc Score”

Insights from Dr. William Knaus, Creator of the APACHE II Score

The APACHE II Score is the most-referenced risk score for ICU mortality, with over 15,000 citations in PubMed since its publication 22 years ago, and is still used today both clinically and in research. We talked with Dr. William Knaus, first author on the APACHE paper, about his experience in developing the APACHE II Score, as well as the increasing need for technology in healthcare (and its disappointing uptake and implementation).

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Dr. William Knaus

When we started [developing APACHE] in the 1970s, DRGs [diagnosis-related groups] were just coming on the scene, and obviously they were oriented towards the business and financing aspects of healthcare. There’s little correlation to the clinical. But people were relying on DRGs as a way to classify and identify patients, especially in the ICU. So it was important at that time to not so much reinvent the diagnostic system, but to talk about how patients come in at different levels of severity. And at that time, there was really nothing out there. Continue reading “Insights from Dr. William Knaus, Creator of the APACHE II Score”

First Scurvy, Now Sepsis: Is Vitamin C the New Old Wonder Drug?

See Dr. Marik’s response to this article. 

fresh-orange-juice-529486301-5828e1903df78c6f6abe5c9aA recent small single-center before-and-after trial by Marik et al showed that vitamins in combination with other relatively safe therapies may improve outcomes in sepsis. We asked three critical care physicians to give their thoughts on the debate on vitamin C in sepsis, and our own co-founder and healthcare finance expert Joe Habboushe to weigh in on the cost/price argument. Continue reading “First Scurvy, Now Sepsis: Is Vitamin C the New Old Wonder Drug?”

Insights from Dr. Christopher Seymour, Creator of the qSOFA Score

Ah, sepsis. You can’t solve a problem without defining it, and sepsis has been notoriously difficult to define, let alone treat. The body of data on sepsis is growing, as well as laypeople’s awareness of the disease. Yet it still manages to elude clinicians in many ways. We talked to Dr. Christopher Seymour, Sepsis-3 investigator and creator of the qSOFA Score, about using qSOFA to help in the management of sepsis.

Bonus: We also asked Dr. Seymour about his thoughts on vitamin C in sepsis. Come back to Paging MDCalc next week to see what he (and other critical care docs) had to say! Continue reading “Insights from Dr. Christopher Seymour, Creator of the qSOFA Score”

Insights from Dr. Sofia Barbar – Creator of the Padua Prediction Score for Risk of VTE

The Padua Prediction Score is one of several validated venous thromboembolism (VTE)-related risk scores. It’s particularly useful in helping to determine whether hospitalized inpatients, who often have multiple comorbidities and thus multiple VTE risk factors, would benefit from pharmacologic prophylaxis over mechanical prophylaxis. We interviewed the first author on the derivation study, Dr. Sofia Barbar, for her insights on developing and using the Padua Prediction Score. Continue reading “Insights from Dr. Sofia Barbar – Creator of the Padua Prediction Score for Risk of VTE”

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”

Deciphering Cryptogenic Stroke with Dr. David Thaler, Creator of the RoPE Score

Paradoxical embolism via patent foramen ovale (PFO) is a rare cause of stroke, but it’s not uncommon to find PFOs in patients without traditional stroke risk factors (about 1 in 4 people in the general population have a PFO). How should patients with no other convincing cause of stroke be counseled, especially if invasive PFO closure is being considered? We talked to Dr. David Thaler, creator of the Risk of Paradoxical Embolism (RoPE) Score, about his research and experience with taking care of patients with cryptogenic stroke.

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Dr. David Thaler

Why did you develop the RoPE Score? Was there a clinical experience that inspired you to create this tool for clinicians?

PFOs have interested and frustrated me for years. They’re so common in the general population, and we find them all the time in stroke patients, old ones and young ones. And paradoxical embolism is definitely a thing—there’s no question that it happens—but because the prevalence is so high in the general population, there’s also no question that a lot of the PFOs that we find are incidental. That’s where this started from in my mind: Continue reading “Deciphering Cryptogenic Stroke with Dr. David Thaler, Creator of the RoPE Score”

Dr. Suzanne Rosenfeld on the Dos and Don’ts of Vaccines

Dr. Suzanne Rosenfeld, MDSuzanne Rosenfeld, MD, is co-founder of West End Pediatrics, a private practice in New York City. Formerly, she directed the Pediatric Emergency Room and also supervised in the Adolescent Medicine training of pediatric residents at The New York Hospital/Cornell Medical Center. Dr. Rosenfeld maintains an active teaching career at Cornell Medical Center and Columbia College of Physicians and Surgeons.

She sat down with us to give our users a some expert advice on the difficulties of vaccinations and some tips to use with patients.

MDCalc: What are some of the challenges you face when trying to vaccinate patients? How do you overcome these challenges?

Suzanne Rosefeld: The vast majority of my patients understand the importance of childhood vaccines. Before vaccinating each child I explain what the vaccine I am recommending is for. In the cases where there is hesitancy I make sure I answer every one of their questions. I listen to their concerns and address, using hard scientific evidence in terms of risk/benefit, each issue.

MDC: What are some of the most common cases in which you do not vaccinate patients?

SR: I do not vaccinate a child if they are at the beginning of an illness, even if its “just a cold”. Vaccines do not “make one sick” (with the exception of the live virus vaccines) but can “distract” the immune system. I am privileged by having a very responsible parent body and find that they 1) appreciate my considerations and, more importantly, 2) return at the recommended time to get the deferred vaccines. Continue reading “Dr. Suzanne Rosenfeld on the Dos and Don’ts of Vaccines”