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.
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”
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).
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”
See Dr. Marik’s response to this article.
A 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?”