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Medical editors
•  A. Lemoine, MD
•  R. von Simson, MBBS, MSc, DLSTHM, MRCEM
•  Tomer Barak, MD, MSc, DTM&H
Copy editor: Florian Matern, M.A

Best wishes
Your Amboss team

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#3: Eat, sleep, console, repeat

⭕️10-second takeaway
Standard management of neonatal opioid withdrawal syndrome may lead to unnecessary use of opioids and long hospital stays. In this trial, infants managed with a function-based assessment and prioritization of nonpharmacological interventions (the Eat, Sleep, Console approach) were less likely to receive opioids and were discharged from the hospital earlier than infants managed with standard care, while safety outcomes were similar. The Eat, Sleep, Console approach for neonatal opioid withdrawal syndrome shows promise, but further research on long-term outcomes is needed.

Read more about neonatal abstinence syndrome >
Study breakdown
Study population: 1305 infants with neonatal opioid withdrawal syndrome born at ≥ 36 weeks’ gestation

Methods: multicenter, cluster-randomized, controlled trial at 26 hospitals
Randomization of hospitals to 1 of 8 blocks that were each randomly assigned a 3-month time period to transition from usual care to console care
At each site, infants were enrolled before and after (but not during) the transitional period.
Primary outcome: time from birth to being medically ready for discharge
Secondary outcomes: use of pharmacological treatment, duration of hospitalization
Safety outcomes from discharge to 3 months of age: in-hospital safety, unscheduled health care visits, nonaccidental trauma, and death
Main results
837 infants met readiness for discharge.
Compared to the usual-care time period, infants treated during the console-care time period were:
Medically ready for discharge earlier (8.2 days vs. 14.9 days; 95% CI, 4.7–8.8)
Less likely to receive opioids (19.5% vs. 52%; relative risk, 0.38; 95% CI, 0.30–0.47)
Safety outcomes for infants managed before, during, and after the transitional period were similar.
Limitations include:
Long-term follow-up data is not available (to date).
Confounding temporal trends (e.g., earlier newborn discharge during the COVID-19 pandemic)
Study funding: National Institutes of Health
Original study
Young LW, Ounpraseuth ST, Merhar SL, et al. Eat, Sleep, Console approach or usual care for neonatal opioid withdrawal. N Engl J Med, 2023. doi: 10.1056/NEJMoa2214470

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#2: Continue screening at-risk individuals for LTBI

⭕️10-second takeaway
Up to 13 million individuals living in the US have latent tuberculosis infection (LTBI). Identification and treatment of LTBI are crucial in preventing the development of active TB and consequent transmissibility, morbidity, and death. The United States Preventive Services Task Force (USPSTF) has reaffirmed its 2016 recommendation to screen for LTBI in adults at risk for infection. Medical providers should use clinical judgment to determine screening intervals.

Read more about latent tuberculosis infection >
Recommendation breakdown
Recommendation: The USPSTF concluded with moderate certainty that there is a benefit to screening for LTBI in adults at risk for infection.

Applicable population
Asymptomatic adults ≥ 18 years of age at increased risk for TB infection
Risk factors for infection include having lived in:
Countries with high TB prevalence
Crowded living spaces (e.g., homeless shelters, prisons)
Additional information
This recommendation does not apply to:
Children and adolescents
Symptomatic individuals
Individuals who receive screening as standard of care (i.e., those with a history of immunosuppression, those who work in high-risk environments)
Individuals exposed to a person with active TB
Screening is performed by either tuberculin skin test (TST) or interferon-gamma release assay (IGRA).
Both tests have moderate sensitivity and high specificity for LTBI.
Limitations include:
The USPSTF did not find sufficient evidence to provide recommendations on screening frequency.
Available data comparing the outcomes of screened vs. unscreened individuals is limited.
Study funding: Agency for Healthcare Research and Quality (AHRQ)

Original study
US Preventive Services Task Force. Screening for latent tuberculosis infection in adults: US Preventive Services Task Force recommendation statement. JAMA, 2023. doi: 10.1001/jama.2023.4899

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#1: Contrast-enhanced CT to evaluate abdominal pain

⭕️10-second takeaway
Contrast-enhanced CT (CECT) is the preferred modality for evaluation of acute abdominal pain in the emergency department (ED). However, unenhanced CT is used in patients with contraindications to contrast (e.g., renal impairment, hypersensitivity). This study found unenhanced CT to be significantly inferior to CECT in the ED diagnosis of patients with acute abdominal pain. Contraindications to contrast should be weighed carefully against the diagnostic benefits of CT with contrast.

Read more about acute abdomen >
Study breakdown
Study population: 201 consecutive patients ≥ 18 years of age (mean age 50 years; 54% female; mean BMI 25.5) who had undergone dual-energy CECT (with oral and IV contrast) of the abdomen and pelvis in a single ED for the evaluation of acute abdominal pain

Methods: multicenter, retrospective diagnostic accuracy study
CECT reference interpretation was established by 3 radiologists.
Contrast was digitally subtracted to produce unenhanced CT images.
Unenhanced CT images were interpreted by 6 radiologists (1 faculty and 1 resident from 3 institutions) who were blinded to the reference CECT
Primary outcome: diagnostic accuracy of unenhanced CT for the primary cause of abdominal pain
Secondary outcome: diagnostic accuracy of unenhanced CT for clinically significant incidental findings
Main results
Unenhanced CT was approximately 30% less accurate in identifying both the primary cause of abdominal pain and clinically significant incidental findings.
Overall diagnostic accuracy of faculty and residents was similar.
Overall diagnostic accuracy was slightly lower in older patients but was not affected by gender or BMI.
Limitations include:
Retrospective design evaluating imaging with contrast digitally subtracted rather than actual non-contrast-enhanced imaging.
The study did not evaluate the diagnostic accuracy of oral contrast-enhanced studies, which are less commonly avoided than IV contrast-enhanced studies.
Study funding: Michigan Institute for Clinical and Health Research

Original study
Shaish H, Ream J, Huang C, et al. Diagnostic accuracy of unenhanced computed tomography for evaluation of acute abdominal pain in the emergency department. JAMA Surg, 2023. doi: 10.1001/jamasurg.2023.1112

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One-Minute Telegram | #75, May 2023

The One-Minute Telegram is a journal club for busy doctors, with the latest research distilled down to just one minute.

Here is your latest edition with the following studies:

1-Should ED providers have a lower threshold for using contrast for CT?

2-USPSTF reaffirms screening recommendations for individuals at risk for LTBI.

3-Exploring function-based assessment and nonpharmacological treatment for neonatal opioid withdrawal syndrome

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