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Showing posts from April, 2016

Derivation and validation of two decision instruments for selective chest CT in blunt trauma: a multicenter prospective observational study (NEXUS Chest CT)

Journal Club Summary Methodology Score: 3/5                  Usefulness Score:  3/5
Authors: Rodriguez RM, et al. PLoS Med. 2015 Oct 6;12(10):e1001883. Full Article
This study derived and validated a clinical decision rule for CT imaging in blunt thoracic trauma (NEXUS CT Chest rule) that was found to have a sensitivity of 99.2% for “major injury” and 95.4% for “major and minor injury” and a specificity of 25.5% and 31.7% respectively. This study had certain methodological flaws such as including patients with GCS<15 and including independent variables open to interpretation (ex: distracting injury) but does serve to illuminate historical and physical exam findings predictive of significant thoracic injury. By: Dr. Simeon Mitchell

Epi lesson: Validation of Clinical Decision Rules Critical appraisal criteria for a paper that validates an existing decision rule are different than those for a study that derives or creates the rule. Most important is that the study evaluates the existing rule…

Oral Prednisolone in the Treatment of Acute Gout: A Pragmatic, Multicenter, Double-Blind, Randomized Trial.

Journal Club Summary
Methodology Score: 4/5                  Usefulness Score: 4/5
Rainer TH, et al. Ann Intern Med. 2016 Feb 23. doi: 10.7326/M14-2070. Abstract Link
This multicenter, double-blind, randomized equivalence trial enrolled 416 patients in 4 EDs in Hong Kong found that oral prednisolone and indomethacin had similar analgesic effectiveness among patients with acute gout, with patients on prednisolone having significantly fewer minor side effects. While the group felt that this rigorous study supports the use of a systemic steroid as an alternate first line for acute gout, their preference was still colchicine or naproxen unless there were contraindications. By: Dr. Andrea Lo

Epi lesson Equivalence or Non-Inferiority Trials Most RCTs aim to determine whether one intervention is superior to another (superiority trials). Often a non-significant test of superiority is wrongly interpreted as proof of no difference between the two treatments. By: contrast, equivalence trials aim to dete…

Transgender Health in the ED