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Showing posts from September, 2015

A Randomized Trial of Icatibant in ACE-Inhibitor–Induced Angioedema

Methodology Score: 1.5/5                 Usefulness Score: 1/5
Baş M, Greve J, Stelter K, et al. N Engl J Med. 2015 Jan 29;372(5):418-25
Full Article
This small phase 2, multicenter, double blind randomized trial of 30 ED patients found a shorter time to complete resolution of ACE-I induced angioedema with a bradykinin antagonist, icatibant, compared with standard therapy (glucocorticoids and antihistamines). While the premise showed promise, JC attendees were disappointed by the lack of allocation concealment, no intention to treat analysis, loss to follow-up and wide confidence intervals. Further high quality study is required before considering this therapy for this challenging population. By: Dr. Ian Taylor

Epi Lesson: Intention to Treat vs. Per Protocol Analyses

Association of Pyuria and Clinical Characteristics With the Presence of Urinary Tract Infection Among Patients With Acute Nephrolithiasis

Methodology Score:    2.5/5                Usefulness Score:  2.5/5
Abrahamian FM, Krishnadasan A, Mower WR, et al. Ann Emerg Med. 2013 Nov;62(5):526-33.
Abstract Link
Pyuria alone cannot be used to determine if UTI is present in patients with acute nephrolithiasis. Pitfalls of this prospective observational study included convenience sampling, workup bias and lack of patient follow-up after ED discharge. Despite these limitations, considering this and other literature supporting the poor sensitivity and specificity of urinalysis, JC attendees agreed that a composite of pyuria, fever, female gender, and clinical gestalt should be used to help guide decision making for management and disposition of these patients.  By: Dr. Carly Rogenstein (Presented May 2015)

Epi Lesson: Spectrum bias

Opioid Alternatives in Acute Severe Pain