The Journal of Emergency Medicine 749

the ED after successful reduction with air enemas and that delayin diagnosis is associated with poor outcome.

[Java Tunson, MD

Denver Health Medical Center, Denver, CO]

Comments: This paper elucidates the risk of delayed diag-nosis in intussusception but is optimistic in the rates of success-ful reduction with a minimally invasive air enema. It would beprudent for emergency physicians evaluating children for inter-mittent abdominal pain to expand their differential diagnosis toinclude intussusception despite atypical presentations and atyp-ical age groups as the diagnostic modality, and the intervention,when done early, is low risk and when missed, can lead to sig-nificant morbidity.

, EFFECTS OF HABITUAL COFFEE CONSUMPTIONON CARDIOMETABOLIC DISEASE, CARDIOVAS-CULAR HEALTH, AND ALL-CAUSE MORTALITY.O’Keefe JH, Bhatti SK, Patil HR. J Am Coll Cardiol 2013;62:1043�51.

The United States (US) consumes the most coffee of anynation, with two-thirds of the population drinking this beveragemade up of multiple compounds. Caffeine is the most studied,and varies depending on preparation, size of beverage, andtype of coffee. This study examines existing data regarding cof-fee consumption and its effect on health and all-cause mortality.Coffee consumption confers a benefit in the reduction of Type IIdiabetes mellitus (T2DM). There was significant reduction in adose-dependent relationship of coffee consumption and reduc-tion of T2DM. Caffeinated and noncaffeinated beverages conferthe same benefit. The authors conclude that coffee’s effect onserum lipids is a dose-dependent increase in serum total choles-terol and a nonsignificant increase in low-density lipoproteinconcentrations in only boiled preparations of coffee, but notfor filtered coffee. Filtered coffee had no effect on cholesterolconcentrations. Interestingly, moderate coffee consumptionmight decrease the long-term risk of coronary heart disease(CHD) where consuming > 1 or 2 cups of coffee daily was asso-ciated with a relative risk (RR) of 0.87 for developing CHD(p = 0.001). When examining the consumption of coffee withcongestive heart failure (CHF), there is evidence that bothhigh and low (but not moderate amounts) of coffee consumptionincreased the incidence of CHF. Finally, this review demon-strates a nonsignificant change in systolic and diastolic bloodpressure in coffee drinkers compared with the control groupand shows no clinically significant effect of long-term coffeeconsumption on risk of hypertension. Prior belief that coffee in-creases dysrhythmia is not supported. There is an inverse rela-tionship between drinking coffee and risk of hospitalizationfor dysrhythmia amongst all comers. People who drank morethan four cups of coffee a day had fewer cardiac dysrhythmiasand less atrial fibrillation. Additionally, patients with prior ST-segment elevation myocardial infarction do not have increasedrisk for dysrhythmia. In researching the effect of coffee on therisk of ischemic stroke, one to three cups of coffee were associ-ated with a decreased risk of stroke (RR 0.82, 95% confidenceinterval 0.74�0.90, p < 0.001) in men and women. There wasan inverse association with coffee consumption and mortality

from stroke in women that was consistent in the diabetic womenas well. Finally, in evaluating coffee consumption and its effecton all-causemortality, an inverse proportion of coffee intake andall-cause mortality exists. This is mostly due to decrease incardiovascular disease-related deaths. Decaffeinated coffeeconferred the same protection. This did not hold true in can-cer-related deaths. Other beneficial effects of coffee con-sumption may include decreased depression, reduced risk ofAlzheimer’s dementia, Parkinson disease, improved asthmasymptoms, and prevention of symptomatic gallstones andsome malignancies of the liver. On the other hand, negative ef-fects of coffee consumption include palpitations, anxiety, trem-ulousness, insomnia, drug interactions, increased urine output,and increased risk of bone loss.

[Java Tunson, MD

Denver Health Medical Center, Denver, CO]

Comments: Coffee is a pervasive part of American culture.As something enjoyed by the majority of the population, it iscompelling to know that coffee seems to confer many healthbenefits at a moderate rate of consumption (barring differentmethods of preparation). There seem to be very few exceptionsto the population who cannot both safely consume and benefitfrom consuming filtered coffee. In the future, it will be inter-esting to know whether these benefits are outweighed by theeffect of the ‘‘venti’’-sized caramel-filled whole-milk coffeebeverages that likely contribute to the obesity epidemic in theUS.

, INHALED CORTICOSTEROIDS AND THE RISK OFPNEUMONIA IN PEOPLE WITH ASTHMA. McKeever T,Harrison TW, Hubbard R, Shaw D. Chest 2013;144:1788�94.

Although there are studies demonstrating a relationship inchronic obstructive pulmonary disease of inhaled corticosteroiduse and increased risk of pneumonia, these authors demonstratea dose-dependent relationship between inhaled corticosteroidsin asthma and increased risk of pneumonia and lower respiratorytract infections (LRTI) (p < 0.001 for trend). Through regressionanalysis of data from The Health Improvement Network the au-thors retrospectively analyzed data from a cohort and found6857 patients with asthma and a LRTI. Patients that had asthmaand smoked, had a higher Charlson Comorbidity Index score,used more frequent rescue inhalers, required more frequentoral steroid bursts, or were from a lower socioeconomic class,were more likely to develop pneumonia or LRTI. The authorsattempted to control for confounders including age, smoking,and the Charlson Comorbidity Index score. They corrected forthe number of oral steroids prescribed for exacerbations andrescue inhaler use to decrease confounders of asthma severity.After adjusting for these confounders, there was a dose-depen-dent relationship where a low beclomethasone dose of# 200 mgshowed no increased risk for pneumonia or LRTI, whereas a be-clomethasone dose of > 250 mg demonstrated an odds ratio (OR)of 2.44 (95% confidence interval [CI] 1.63�2.15) unadjustedfor confounders, and OR of 1.87 (95% CI 1.63�2.15) whenadjusted for the above confounders. Finally, steroid type wasevaluated individually comparing risk of pneumonia or LRTIwith fluticasone and betamethasone, with an OR of 1.20 (95%