Journal Club Summary

Methodology Score: 4/5                   
Usefulness Score: 3.5/5
Hinson JS, et al. Ann Emerg Med. 2017 Jan 19 [Epub ahead of print]
In this large, well-designed retrospective study of AKI following contrast administration for CT in ED patients, IV contrast was not found to be associated with an increased frequency of AKI or subsequent renal failure. When combining this data with emerging recent evidence, local protocols should be updated to reflect that we should not delay emergent contrast-enhanced CT scans waiting for serum creatinine, considering IV fluid administration for patients at moderate to high risk for AKI given other patient factors and co-morbidities (ie advanced age, CHF, HTN, DM, CKD).
By: Dr. Lauren Lacroix

Epi Lesson

In the statistical analysis of observational data, propensity score matching is one of a family of multivariate statistical techniques that attempts to estimate the effect of a treatment or other intervention by accounting for the covariates that predict receiving the treatment. Compared to the gold standard of a randomized controlled trial, any observational analysis and interpretation of the usefulness of an intervention must be viewed with a large degree of healthy skepticism.

By: Dr. Ian Stiell