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Showing posts from August, 2016

High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study

Journal Club SummaryMethodology Score: 3/5                  Usefulness Score: 2/5
Shah, AS, et al. Lancet.2015 Dec 19;386(10012):2481-8 Full Article

Editorial: Myocardial infarction: rapid ruling out in the emergency room Cullen L, et al. Lancet.2015Dec 19;386(10012):2449-50 Editorial Link

This prospective cohort study derived and validated a threshold of <5 ng/L at which the negative predictive value of a single high sensitivity troponin value at presentation was greater than 99.5% for ruling out an acute MI, MI at 30 days, or sudden death at 30 days. Although the methods were well done with consecutive enrollment, blinding, and a suitable reference standard, the group was very concerned about the reliance on reporting negative predictive values as the primary outcome, with insufficient data to calculate sensitivity, specificity, or likelihood ratios. By: Dr. Brandon Ritcey
Epi lessonScreening Tests in the ED 
Diagnostic tests in the ED are often used to screen many patients for the poss…

Corticosteroid Therapy for Patients Hospitalized With Community- Acquired Pneumonia A Systematic Review and Meta-analysis

Journal Club SummaryMethodology Score: 4/5                  Usefulness Score:  3.5/5
Siemieniuk RA, et al. Ann Intern Med. 2015;163(7):519-528.
Abstract Link
This is a well-done systematic review & meta-analysis elucidating whether steroid therapy along with antibiotics benefits patients with community-acquired pneumonia, and incorporates key new studies that were not included in previous reviews.The authors conclude from the overall low-quality evidence that steroids probably have a small effect on some serious patient-important outcomes (ARDS, mechanical ventilation, duration of hospital stay, time to clinical stability) without much evidence of harm, but it's unclear whether they affect mortality, and in whom; the group was divided on whether to incorporate this into current practice. By: Dr. Ashley Krywenky

Epi lesson: Clinical vs Statistical Heterogeneity A meta-analysis may attempt to address a compelling clinical dilemma. But one of the key questions to ask when appraising m…

Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis A Randomized Clinical Trial

Journal ClubMethodology Score: 4.5/5               Usefulness Score: 4.5/5
Freedman, SB, et al. JAMA.2016;315(18):1966-1974.
Abstract Link
This single center, single blinded non-inferiority randomized controlled trial suggests that in children 6-60mo with gastroenteritis and mild dehydration, apple juice/preferred fluids were superior to standard electrolyte maintenance solution with a treatment failure rate of 16.7% vs. 25.0% respectively (NNT 12, ARR -8.3%, 97.5%CI P <0.01 for inferiority and P=0.006 for superiority).The strength of this paper is that it is easily applied to our patient population, however it should be noted that these results have yet to be reproduced in a multicentre trial and we should not apply the results to patients with severe dehydration. By: Dr. Chris Fabian

Epi lessonEquivalence 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 inte…

ACHY BREAKY HEART: Risk Scores for Assessing Chest Pain in the ED