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Showing posts from June, 2015

Epi Lessons - Part 3 - OVERVIEW ARTICLES

As part of our Journal Club summaries our JC Chairs (Drs. Lisa Calder and Ian Stiell@EMO_Daddy) have been tasked with explaining Epidemiological concepts so that everyone in our department can analyze the literature and appraise articles on their own. For this Blog post we have all the "Epi Lesson" as they relate to "Overview Articles". More to follow in the coming weeks.

Epi Lessons - Part 2 - THERAPY ARTICLES

As part of our Journal Club summaries our JC Chairs (Drs. Lisa Calder and Ian Stiell@EMO_Daddy) have been tasked with explaining Epidemiological concepts so that everyone in our department can analyze the literature and appraise articles on their own. For this Blog post we have all the "Epi Lesson" as they relate to "Therapy Articles". More to follow in the coming weeks.

Effect of Prehospital Induction of Mild Hypothermia on Survival and Neurological Status Among Adults With Cardiac Arrest A Randomized Clinical Trial

Methodology Score: 3/5                    Usefulness Score: 2/5
Kim F, et al. JAMA.2014 Jan 1;311(1):45-52. Full Article
Editorial: Randomized Clinical Trial Progress to Inform Care for Out-of-Hospital Cardiac Arrest Granger CB, Becker LB JAMA.2014;311(1):31-32 Article Link
This randomized clinical trial found that early pre-hospital cooling with 2 litres of IV Normal Saline at 4 degrees Celsius did not improve survival (non-VF P = 0.30; VF, P = 0.69) or neurological outcome (non-VF, P = 0.74; VF, P = 0.59) in patients with ROSC and led to higher incidence of pulmonary edema (P < 0.001) and re-arrest (P = 0.008). JC attendees identified concerns with pre-randomization selection bias; however, the study correlates with the body of evidence that suggests that pre-hospital cooling with IV NS is not recommended.  By: Dr. Nicholas Clarridge

Epi Lesson: Selection Bias and Randomization

Epi Lessons - Part 1 - DIAGNOSIS ARTICLES

As part of our Journal Club summaries our JC Chairs (Drs. Lisa Calder and Ian Stiell@EMO_Daddy) have been tasked with explaining Epidemiological concepts so that everyone in our department can analyze the literature and appraise articles on their own. For this Blog post we have all the "Epi Lessons" as they relate to "Diagnosis Articles". More to follow in the coming weeks.

Very early administration of progesterone for acute traumatic brain injury

Methodology Score: 4/5                    Usefulness Score: 2/5
Wright DW, et al.; NETT Investigators. N Engl J Med. 2014 Dec 25;371(26):2457-66 Abstract Link
Complementary Article: A Clinical Trial of Progesterone for Severe Traumatic Brain Injury Skolnick BE, et al; SYNAPSE Trial Investigators. N Engl J Med 2014; 371:2467-2476 Abstract Link
Editorial: Progesterone for Traumatic Brain Injury — Resisting the Sirens' Song Lee H. Schwamm, M.D. N Engl J Med 2014; 371:2522-2523 Abstract Link

This is a large well conducted multicentre randomized control trial demonstrated no benefit with early administration of IV progesterone to traumatic brain injury patients ( GCS 4-12) within 4hrs of injury. JC attendees felt that as progesterone is not a regular intervention for traumatic brain injury, the trial would have little impact on their clinical practice.

Lower versus higher hemoglobin threshold for transfusion in septic shock

Landmark Series
Methodology Score: 4/5                    Usefulness Score: 4/5
Holst LB et al for the TRISS Trial Group and the Scandinavian Critical Care Trials Group. N Engl J Med. 2014 Oct 9;371(15):1381-91
Full Article
Editorial: Transfusion Threshold of 7 g per Deciliter — The New Normal Paul C. H├ębert, M.D., and Jeffrey L. Carson, M.D. N Engl J Med 2014; 371:1459-1461 Editorial Link
This multicenter, randomized trial of ICU patients with septic shock, found no significant difference in mortality at 90 days or in secondary outcomes for a hemoglobin transfusion threshold of 7 g/dL compared to 9 g/dL.  This was a well-conducted study with high relevance in critical care, and JC attendees felt that the results aligned with both the landmark TRICC trial advocating restrictive transfusion thresholds, and recent literature in sepsis showing that "down-stream" interventions (e.g., EGDT) may have less importance in influencing clinical outcomes.  By: Dr. George Mastoras (Presented January…

Choosing Wisely Canada: Emergency Medicine

With the Choosing Wisely Canada campaign underway, Emergency Medicine recently published their list of "5 Things Physicians and Patients should question" in conjunction with the Canadian Association of Emergency Physicians. Here we'll list the 5 "things" for you to quickly reference and for the full list, explanations, and references please go to Choosing Wisely Canada: Emergency Medicine. Given this is a Canadian endeavour each of the recommendations includes it's Canadian Article and FOAMed references that you can go to if you want to learn more about each topic. Maybe we should have saved this post for July 1st!



1) Don’t order CT head scans in adults and children who have suffered minor head injuries (unless positive for a head injury clinical decision rule).Canadian References:
1) CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury
2) The Canadian CT Head Rule for patients with minor head injury
Canadian FOA…

Emergency ultrasound-assisted examination of skin and soft tissue infections in the pediatric emergency department

Methodology Score: 3/5                    Usefulness Score:  3/5
Marin JR, Dean AJ, Bilker WB, Panebianco NL, Brown NJ, Alpern ER. Acad Emerg Med. 2013 Jun;20(6):545-53
Full Article
This prospective single-centre study found that where a clinical question exists regarding the need for drainage of a superficial soft tissue infection in the pediatric population, that the addition of ultrasound to the clinical exam had a theoretical sensitivity of 77.6% (95% CI = 1.2% to 66.6%; difference of 33.9% over clinical exam alone). The group agreed that the overall clinical benefit to patients was uncertain, and that local practice behaviour was unlikely to change as a result of this paper.  By: Dr. Taylor Lougheed

Epi lesson: Did Participating Patients Present a Diagnostic Dilemma?