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Showing posts from April, 2015

Comparison of the "real-life" diagnostic value of two recently published electrocardiogram methods for the differential diagnosis of wide QRS complex tachycardias

Methodology Score: 2/5                   Usefulness Score:  2/5
Szelényi Z, et al.Acad Emerg Med.2013 Nov;20(11):1121-30.
Abstract Link
This retrospective cohort study found that the Vereckei algorithm for differentiating between VT and SVT with aberrancy on wide complex tachycardia (WCT) EKGs in a non-clinical setting had a sensitivity and specificity of 92.4% and 64.7% for identifying VT, while the RWPT algorithm had a sensitivity and specificity of 79.1% and 80.9%. JC attendees identified multiple methodological errors and sources of potential bias in the study, and overall were concerned with an unacceptable miss rate for a potentially deadly diagnosis. It was agreed that it is safest to manage most WCTs as VT in an ED setting, with the exact role of these algorithms left unclear. By: Dr. Francis Bakewell

Epi Lesson: Why sample size calculations are important

Antiemetic Use for Nausea and Vomiting in Adult Emergency Department Patients: Randomized Controlled Trial Comparing Ondansetron, Metoclopramide, and Placebo

Methodology Score:    3.5/5                 Usefulness Score: 2.5/5
Egerton-Warburton D, Meek R, Mee MJ, Braitberg G. Ann Emerg Med. 2014 May 9. pii: S0196-0644(14)00223-6.
Abstract Link
This prospective placebo-controlled trial found that there is no difference between Ondansetron, Metoclopramide and Placebo in reducing nausea severity in ED patients over 30 minutes [Mean VAS reduction 27 mm (95% confidence interval [CI] 22 to 33 mm), 28 mm (95% CI 22 to 34 mm) and 23 mm (95% CI 16 to 30 mm) respectively]. The group agreed that these results are not generalizable to our patient population, however a future meta-analysis may offer practice changing guidelines.  By: Dr. Michael O’Brien

Epi lesson: Use of Continuous Data as Primary Outcome Beware of studies that compare the effectiveness of interventions by using continuous data outcomes, such as pain scales (1-100), oxygen saturation values, and minutes to pain relief. These kinds of data can produce statistically significant differences betwe…

Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial.

Methodology Score:    4/5                    Usefulness Score:  4/5
Imazio M, et al. Lancet. 2014 Jun 28;383(9936):2232-7.
Abstract Link
This randomized double-blind placebo-controlled trial of colchicine in addition to usual anti-inflammatory therapy for the treatment of recurrent pericarditis showed an impressive relative risk reduction of 0.49 (95% CI 0.24-0.65) for subsequent recurrence over the 18+ month follow-up period. JC attendees had some difficulty with applying these results to ED patients as this was not an ED-specific trial, but felt overall that colchicine would be useful in the rare instances that these patients present primarily to the ED, as long as cardiology follow-up was in place. By: Dr. Christa Dakin (Presented November) 2014

Epi lesson:Flow Diagram Investigators and editors developed the CONSORT Statement (revised 2010 to improve the reporting of randomized controlled trials (RCTs) by means of a checklist and flow diagram. The fl…

Derivation and validation of a clinical prediction rule for uncomplicated ureteral stone--the STONE score: retrospective and prospective observational cohort studies.

Methodology Score: 2.5/5                 Usefulness Score:  2/5
Moore CL, Bomann S, Daniels B, Luty S, Molinaro A, Singh D, Gross CP. BMJ. 2014 Mar 26;348:g2191.
Full Article

This study derived and validated an objective clinical prediction rule which found that a ureteral stone was present in 9.2% of the low score group, 51.3% of the moderate score group, and 88.6% of the high score group while an acutely alternative finding was present in 1.6% of the high score group. The group was very critical of the study methodology as well as a scoring tool utilizing ethnicity as one of five criteria; the clinical utility of the STONE score was felt to be very limited in our local practice. By: Dr. Nicholas Costain (Presented November 2014)

Epi lesson: Major Steps in the Development of a Clinical Decision Rule

Goal-directed resuscitation for patients with early septic shock.

Landmark Series
Methodology Score: 4/5                    Usefulness Score: 5/5
ARISE Investigators and the ANZICS Clinical Trials Group. N Engl J Med. 2014 Oct 16;371(16):1496-506
Abstract Link
ARISE was a multicenter, international ED unblinded RCT that found no difference in all-cause 90 day mortality (ARR 0.3%, NNT 352), and no difference in multiple clinically-important secondary outcomes, between modern day non-protocolized septic shock management and the Early Goal Directed Therapy (EGDT) protocol.  In conjunction with ProCESS, this is a landmark study emphasizing that the key components of the EGDT protocol to optimize septic shock management are early recognition, early antibiotics, and optimal fluid resuscitation. By: Dr. Aseem Bishnoi (Presented November 2014)

Epi lesson: Survival Analyses Survival analyses are used in clinical trials that follow patients over time for primary outcomes such as death, relapse, adverse drug reaction, or development of a new disease. The follow-up time…