Journal Club Summary
Methodology Score: 4.5/5
Usefulness Score: 4.5/5
Pecard R, Starr K, MacLennan G, Lam T, et al.
Published Online May 19, 2015 http://dx.doi.org/10.1016/S0140-6736(15)60933-3
This high quality multicenter, randomized, triple-blind, placebo-controlled study of almost 1,200 adult patients with CT confirmed solitary ureteral stone (<10mm) found no statistically significant differences in using either Tamsulosin or Nifedipine vs placebo for the purposes of preventing urologic intervention at 4wks. Analgesic use, time to stone passage, and overall health status were similar in all three groups. JC attendees found few flaws in this study which should deter emergency physicians from needlessly prescribing these medications in cases of ureterolithiasis.
By: Dr. Tamara McColl
(Presented June 2015)
Epi lesson: Stratification of Randomization to Adjust for Confounding
When there are known confounders which may influence a treatment effect being studied in an RCT, savvy investigators plan their randomizations to control for these. One way to think about this is that they are anticipating and controlling for imbalance in their table 1. By stratifying randomization for known confounders, you ensure your randomized groups are balanced for those traits which may influence the ultimate result.
By: Dr. Lisa Calder