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Showing posts from September, 2013

Subclinical cerebral edema in children with diabetic ketoacidosis randomized to 2 different rehydration protocols

Methodology Score: 2/5   Usefulness Score: 2/5
Glaser NS, Wootton-Gorges SL, Buonocore MH, Tancredi DJ, Marcin JP, Caltagirone R, Lee Y, Murphy C, Kuppermann N. Pediatrics. 2013 Jan;131(1):e73-80
Abstract Link
This pilot randomized controlled trial found that DKA treatment protocols using different rates of fluid infusion were not associated with differences in MRI measures of sub-clinical cerebral edema. JC attendees agreed that while the results were thought provoking, this study was not sufficiently powered (n=18) to be considered practice changing.  By: Dr. Michael O’Brien (Presented May 2013)

Epi Lesson - Blinding of Treatment Allocation

Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence

Landmark Article Series Methodology Score: 4.5/5  Usefulness Score: 4.5/5 Colman I, Friedman BW, Brown MD, Innes GD, Grafstein E, Roberts TE, Rowe BH. BMJ. 2008 Jun 14;336(7657):1359-61
Article Link
​In this well performed meta-analysis, a single dose of 10mg IV Dexamethasone administered before discharge demonstrated an important reduction in migraine recurrence rates (RR 0.74, 95% CI 0.6-0.9 P < 0.05) with a NNT of 9. The same treatment demonstrated no statistically significant effect on migraine pain scores. JC attendees noted in other publications that the reduced recurrence effect is best demonstrated when administered at times when pain scores are lowest (before discharge home).   By: Dr. Shawn Mondoux (Presented May 2013)

Epi lesson - Subgroup analyses in Meta-analysis
Subgroup analyses can be an important source of hypothesis generation. The key element to determine is whether the subgroup analyses were planned a priori. These analyses have greater validity than post hoc analyses wh…