EMOttawa - Emergency Medicine Ottawa

As part of our Journal Club summaries our JC Chairs (Drs. Lisa Calder and Ian Stiell@EMO_Daddy) have been tasked with explaining Epidemiological concepts so that everyone in our department can analyze the literature and appraise articles on their own. For this Blog post we have all the "Epi Lesson" as they relate to "Overview Articles". More to follow in the coming weeks.

As part of our Journal Club summaries our JC Chairs (Drs. Lisa Calder and Ian Stiell@EMO_Daddy) have been tasked with explaining Epidemiological concepts so that everyone in our department can analyze the literature and appraise articles on their own. For this Blog post we have all the "Epi Lesson" as they relate to "Therapy Articles". More to follow in the coming weeks.

Methodology Score: 3/5                    Usefulness Score: 2/5
Kim F, et al. JAMA.2014 Jan 1;311(1):45-52. Full Article
Editorial: Randomized Clinical Trial Progress to Inform Care for Out-of-Hospital Cardiac Arrest Granger CB, Becker LB JAMA.2014;311(1):31-32 Article Link
This randomized clinical trial found that early pre-hospital cooling with 2 litres of IV Normal Saline at 4 degrees Celsius did not improve survival (non-VF P = 0.30; VF, P = 0.69) or neurological outcome (non-VF, P = 0.74; VF, P = 0.59) in patients with ROSC and led to higher incidence of pulmonary edema (P < 0.001) and re-arrest (P = 0.008). JC attendees identified concerns with pre-randomization selection bias; however, the study correlates with the body of evidence that suggests that pre-hospital cooling with IV NS is not recommended.  By: Dr. Nicholas Clarridge

Epi Lesson: Selection Bias and Randomization

As part of our Journal Club summaries our JC Chairs (Drs. Lisa Calder and Ian Stiell@EMO_Daddy) have been tasked with explaining Epidemiological concepts so that everyone in our department can analyze the literature and appraise articles on their own. For this Blog post we have all the "Epi Lessons" as they relate to "Diagnosis Articles". More to follow in the coming weeks.

Methodology Score: 4/5                    Usefulness Score: 2/5
Wright DW, et al.; NETT Investigators. N Engl J Med. 2014 Dec 25;371(26):2457-66 Abstract Link
Complementary Article: A Clinical Trial of Progesterone for Severe Traumatic Brain Injury Skolnick BE, et al; SYNAPSE Trial Investigators. N Engl J Med 2014; 371:2467-2476 Abstract Link
Editorial: Progesterone for Traumatic Brain Injury — Resisting the Sirens' Song Lee H. Schwamm, M.D. N Engl J Med 2014; 371:2522-2523 Abstract Link

This is a large well conducted multicentre randomized control trial demonstrated no benefit with early administration of IV progesterone to traumatic brain injury patients ( GCS 4-12) within 4hrs of injury. JC attendees felt that as progesterone is not a regular intervention for traumatic brain injury, the trial would have little impact on their clinical practice.

Landmark Series
Methodology Score: 4/5                    Usefulness Score: 4/5
Holst LB et al for the TRISS Trial Group and the Scandinavian Critical Care Trials Group. N Engl J Med. 2014 Oct 9;371(15):1381-91
Full Article
Editorial: Transfusion Threshold of 7 g per Deciliter — The New Normal Paul C. Hébert, M.D., and Jeffrey L. Carson, M.D. N Engl J Med 2014; 371:1459-1461 Editorial Link
This multicenter, randomized trial of ICU patients with septic shock, found no significant difference in mortality at 90 days or in secondary outcomes for a hemoglobin transfusion threshold of 7 g/dL compared to 9 g/dL.  This was a well-conducted study with high relevance in critical care, and JC attendees felt that the results aligned with both the landmark TRICC trial advocating restrictive transfusion thresholds, and recent literature in sepsis showing that "down-stream" interventions (e.g., EGDT) may have less importance in influencing clinical outcomes.  By: Dr. George Mastoras (Presented January…