Multicenter Emergency Department Validation of the Canadian Syncope Risk Score

Methodology: 4.5/5 Usefulness: 4.5/5 Thiruganasambandamoorthy V, et al. JAMA Intern Med. 2020 Mar 23;180(5):1-8.  Question and Methods: Prospective cohort validation to predict 30-day serious outcomes among ED patients with syncope Findings: 3819 patients had an overall 3.6% serious event rate at 30-days. At a score of -1, the CSRS had a Sn/Sp/NPV of 97.8%/44.3%/100% Limitations: Overlap in recruitment sites and […]

Diagnosis and Outpatient Management of Chronic Obstructive Pulmonary Disease: A Review

Methodology: 1/5 Usefulness: 2/5 Riley CM, et al. JAMA. 2019 Feb 26;321(8):786-797. Question: Aimed to review and provide practical information regarding the diagnosis and long-term management of patients with COPD in the outpatient setting. Methods: This was a systematic assessment where authors searched multiple sources and simply reviewed articles. Findings: They suggested the treatment of COPD should be done on a step-wise […]

The Status on Status: Management of Status Epilepticus

Status epilepticus (SE) is considered one of the most common neurological emergencies with an estimated incidence of 20 cases/100,000 people worldwide. Just the facts The distribution is bimodal, peaking in patients <1 and >60 years old.  In children, the cause is predominantly from febrile illnesses, with or without infection, and in adults it is largely secondary to acute damage from […]

Electrical versus pharmacological cardioversion for emergency department patients with acute atrial fibrillation (RAFF2): a partial factorial randomised trial.

Methodology: 4.5/5 Usefulness: 4/5 Stiell IG, et al. Lancet. 2020 Feb 1;395(10221):339-349 Editorial: Atrial fibrillation cardioversion in the emergency department.  Question and Methods: This partial factorial randomized trial aimed to determine which rhythm control strategy was superior; procainamide followed by electrical cardioversion if needed compared with electrical cardioversion alone. It also sought to determine whether anterolateral or antero-posterior pad placement […]

What a headache: Updates on Migraine Management

Migraine headaches are not a benign disease – they have a significant impact on quality of life, ability to function, and pose a considerable economic and societal burden. Prevalence tends to peak during peoples’ period of highest productivity.  According to the World Health Organization’s (WHO) update on Global Burden of Disease (2004), a severe migraine is considered to be as disabling […]

Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs

Methodology: 2.5/5           Usefulness: 3/5 Daley JI, et al. Acad Emerg Med 26 (11), 1211-1220 Nov 2019 Questions and methods: In patients with abnormal vital signs, what is the sensitivity of FOCUS for the diagnosis of PE? Prospective, multicenter, observational study. Findings: 136 patients with pending CTPE, subdivided in (1) HR≥100 BPM and/or sBP <90 mmHg, […]

Use of a Rapid Diagnostic for Chlamydia Trachomatis and Neisseria Gonorrhoeae for Women in the Emergency Department Can Improve Clinical Management: Report of a Randomized Clinical Trial

Methodology: 3/5           Usefulness: 2.5/5 Gaydos CA et al. Ann Emerg Med. 2019 Jul;74(1):36-44. doi: 10.1016/j.annemergmed.2018.09.012. Epub 2018 Nov 2. Question and Methods: RCT of women receiving pelvic testing for CT/NG comparing standard of care test (NAAT) vs. POC test (GeneXpert). Treatment was at the discretion of the clinician Findings: CT undertreatment rate difference –46.2%; 95% CI […]

Complications of Assisted Reproductive Technology

Assisted reproductive technology (ART) is an evolving field with many therapies that have a common goal: to maximize the chance of pregnancy while minimizing the risk of multiple gestations. As the Canadian infertility rate approaches 15%, the use of ART is steadily increasing (1). In fact, 1-4% of all newborns in industrialized nations are conceived with assisted reproductive technology (2). […]