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Showing posts from August, 2015

Adjunct prednisone therapy for patients with community-acquired pneumonia: a multicentre, double-blind, randomised, placebo-controlled trial.

Methodology Score: 3/5
Usefulness Score: 2/5Blum CA, Nigro N Briel M, et al. Lancet. 2015 Jan 16. pii: S0140-6736(14)62447-8.

Abstract Link

This randomized, double-blinded, placebo-controlled trial demonstrated an improved time to ‘clinical stability’ in patients treated with prednisone for community acquired pneumonia. The study did not examine a clinically important primary outcome, and so the relevance of their findings is of questionable significance; prednisone is not yet ready to be considered the standard of care in community-acquired pneumonia.
By: Dr. Shahbaz Syed
(Presented March 2015)

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 may range from hours to years and a different set of statistical procedures are employed to analyze the data. Terms frequently seen in papers with survival analyses inclu…

Platelets: who needs them?

Guest post by: Dr. Michael Ho
Platelets: too much, too little, don't work. The approach to platelet emergencies is perhaps a little bit more complicated than that, so we attempt to breakdown a simplified approach to platelets in the Emergency Department (ED). Patients with various disease processes often present to the emergency department with critically low platelet counts.
When should we consider transfusing these patients prophylactically to prevent bleeding?
Some of these patients may require a procedure (such as lumbar puncture, central line or paracentesis) in the ED. 
When is it safe to do these procedures? When should we consider transfusing during/prior to these procedures to prevent severe bleeding?
The following should provide a simple guide to some of these platelet-related dilemmas in the ED.
Prophylactic platelet transfusions:1. Thrombocytopenia associated with chemotherapy:
Most studies of spontaneous bleeding derived from hospitalized patients with hematologic malignanci…

Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study

Methodology Score: 2.5/5
Usefulness Score: 2/5

Nijman RG, et al. BMJ. 2013 Apr 2;346:f1706.  Full ArticleThis was a derivation, cross-validation, and external validation of a decision rule for the febrile pediatric patient to identify who is at risk of a serious bacterial infection, pneumonia, or not at risk. While the study contained a large number of patients, the rule was felt to not be clinically useful, as it used clinical features many of us already use to make our clinical decisions, had too many indeterminate results, and required blood work to obtain a CRP.  By: Dr. Hasan Sheikh (Reviewed March 2015) 

Epi lesson: What is a Clinically Sensible Clinical Decision Rule? 
Clinical decision rules for emergency medicine should be “clinically sensible.” This means the rules should be easy to use and comprised of as few variables as possible. Emergency physicians prefer rules that give a simple yes/no answer or use a basic scoring system that can be quickly calculated. The component variable…

Abdominal X-Rays: What's the Point?

Guest post by Dr. Krishan Yadav
Undifferentiated abdominal pain; three words that give every Emergency Physician (EP) the shivers.