Evidence Rounds

Haloperidol may benefit both hyperactive & hypoactive ICU delirium, but likely more for the former. Post-hoc Bayesian analysis of AID-ICU: +4.5 vs +1.6 days alive/out of hospital, with ~67% probability of ≥1 additional day of benefit in hyperactive delirium

Monitor unexplained syncope? 14d ECG monitoring detected more clinically significant arrhythmias (22% vs 9%), lowered 1-year death (1.5% vs 2.9%) & non-significantly reduced primary outcome, recurrent syncope (ratio 0.89, 0.7-1.2)

More fluids or earlier vasopressors for septic shock? ARISE FLUIDS trial found no difference in days alive & out of the hospital between the two strategies after patients had received ~1.5L of initial fluid. Either approach appears reasonable; tailor the next step to the patient

Two recent trials challenged the historical preference for anti-staphylococcal penicillin. For MSSA bacteremia, cefazolin should be first-line, and when the isolate is penicillin susceptible, benzylpenicillin is the preferred narrow-spectrum option

In a proof-of-concept AI second opinion study of 76 ED visits, an LLM exceeded 2 independent MD reviewers on diagnostic performance at 3 touchpoints (ER triage, ER physician & admit) Whether it outperforms physicians in real-world practice is yet to be determined

In a double-blind RCT of 108 obese AUD pts motivated for sobriety, semaglutide reduced heavy drinking days by 13% (absolute) vs placebo Reduction in drinking strongly correlated w/ weight los Suggests shared mechanism or functional unblinding, which might exaggerate benefits

Do patients on a low dose of levothyroxine truly have hypothyroidism? In a multicenter longitudinal descriptive study, 64% on a levothyroxine dose of 50 µg/d or lower were able to successfully discontinue treatment, suggesting that very low doses more often reflect overtreatment

Does hydration reduce kidney stones? A behavioral intervention ↑ fluid intake ~300 mL (w/ slight ↑ urinary symptoms) but did NOT ↓ recurrence or improve outcomes Intake difference may have been too small, as a prior small trial showed benefit w larger separation (~2.5 vs 1L)

Minocycline for acute ischemic stroke? In a multicenter RCT, oral minocycline within 72h of an ischemic stroke (NIHSS 4–25) improved functioning at 90 days (mRS 0–1: 52.6% vs 47.4%; ~5% absolute; RR 1.11), supporting a modest neuroprotective benefit