EMOttawa - Emergency Medicine Ottawa

Methodology Score: 3.5/5 Usefulness Score: 4/5
De Backer D, Aldecoa C, Njimi H, Vincent JL.
Crit Care Med.2012 Mar;40(3):725-30.
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This meta-analysis of 6 trials found that in patients with septic shock, dopamine administration was associated with greater mortality (RR 1.12, 95% CI 1.01-1.20; P=0.035) and a higher incidence of arrhythmic events (RR 2.34) compared to norepinephrine administration. The analysis was dominated by one large but negative trial by the same author and JC attendees were split as to whether norepinephrine should replace dopamine for septic shock.
By: Dr. Debra Eagles

Methodology Score: 3/5 
Usefulness Score: 3/5
Douma RA, Mos IC, et al. Prometheus Study Group.

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This European study directly compared four clinical decision rules in combination with d-dimer testing to exclude PE without the need for CT and found similar performance with very high sensitivity for all four; the authors concluded that simplified Wells or Geneva scores can be used. Limitation to usefulness in the ED include the fact that the study included 20% inpatients, the outpatient group did not stipulate that it was an ED population, exclusion criteria included patients with a previous diagnosis of PE even though this is factored into all four CDRs, and the fact that many Canadian ED physicians already use the simplified Wells score.
By: Dr. Laura Francis