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Showing posts from August, 2014

A Randomized Trial of Colchicine for Acute Pericarditis

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Methodology Score: 4.5/5                           Usefulness Score: 4.5/5
Imazio M1, et al. ICAP Investigators. N Engl J Med. 2013 Oct 17;369(16):1522-8.
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This multicentre double-blind RCT found that a 3 month course of low-dose colchicine is superior to placebo in reducing recurrence rates after first-episode pericarditis (NNT 4, ARR 0.2, RRR 0.56). The group felt that colchicine should be considered in first-episode pericarditis, but raised concerns about the cost of the drug for patients with no drug coverage.  By: Dr. Christa Dakin

Epi lesson: Data Safety Monitoring Boards
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Sensitivity of Bedside Ultrasound and Supine Anteroposterior Chest Radiographs for the Identification of Pneumothorax After Blunt Trauma

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Landmark Series Methodology Score: 4/5                  Usefulness Score: 4/5
Wilkerson RG, Stone MB. Acad Emerg Med. 2010 Jan;17(1):11-7.
Article Link This evidence-based literature review of four prospective observational studies identified that bedside ultrasound had excellent sensitivity (86-98%) especially compared to supine AP xray (28-75%) for identifying pneumothorax after blunt trauma.The group discussed that this was a practice changing article when it was published in 2010, expanding the applications of bedside ultrasound in blunt trauma. By: Dr. Amanda Collier (presented Mar 2014)

Epi lesson: PICOS When reviewing systematic literature reviews, pay attention to how the research question is phrased. High quality studies will follow the PRISMA guidelines’ suggestion to use the PICOS (participants, interventions, comparisons, outcomes, study design) format. A precise research question will guide study selection and should also dictate how table 1 summarizes the included studies.  Hav…
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Red flags to screen for malignancy and fracture in patients with low back pain: systematic review

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Methodology Score: 2.5/5               Usefulness Score: 2.5/5
Downie A, et al. BMJ 2013;347:f7095
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This Cochrane review of the diagnostic accuracy of red flags for fracture or malignancy in patients with low back pain in multiple settings found that corticosteroid use (+LR 4-48.5), severe trauma (+LR 3.4-10), presence of overlying contusion (+LR 31.1, single study), or history of cancer (+LR 15.3-35) had the highest diagnostic utility in predicting need for imaging. However, the overwhelming heterogeneity in setting, design and results of the 14 studies analyzed precluded pooling and suggests that these likelihood ratios should be interpreted with a great deal of caution.Future research is needed to look at the sensitivity & specificity of combining multiple red flags for ED patients with low back pain in order to be clinically useful.  By: Dr. Francis Bakewell (Presented March 2014)

Epi lesson: Bayesian approach to pre-test and post-test probabilities
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Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial

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Landmark Series Methodology Score: 4/5                  Usefulness Score: 4/5
CRASH-2 trial collaborators Lancet. 2010 Jul 3;376(9734):23-32.
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This large RCT assessed the effect of early administration of tranexamic acid to trauma patients and revealed statistically significant results in favour of TXA for the reduction of overall death and death from bleeding without significant adverse effects (0.91 (95% CI 0.85–0.97, p=0·0035); NNT 67). The group felt this was methodologically sound and practice changing trial however questions were raised as to some aspects of the selection criteria ("physicians uncertainty"). By: Dr. Pamela Kapend (Presented Feb 2014)

Epi lesson:Number Needed to Treat (NNT)
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