Journal Club Summary
Methodology Score: 4/5
Usefulness Score: 2/5
Karlow N, et al. Acad Emerg Med. 2018 Oct;25(10):1086-1097.
Question and Methods: This was a systematic review and meta-analysis of low dose ketamine (LDK 0.3 – 0.5mg/kg) vs opioids for acute pain management in the ED.
Findings: 3 studies were included suggesting LDK IV push was non-inferior to IV opioids for acute pain. The LDK group had greater non-serious side effects.
Limitations: Only 3 small studies with moderate heterogeneity. Ketamine dosage may be higher than needed. Recent literature suggests ketamine infusion may be preferable to IV push.
Interpretation: More research is needed to determine whether LDK is a feasible alternative to IV opioids as first line therapy for acute pain in the ED.
Reporting Standards for Systematic Reviews
The PRISMA statement was developed to establish preferred reporting guidelines for systematic reviews and meta-analyses and includes a 27-item checklist and four-phase flow diagram. Observational studies are considered a lower level of evidence for interventions and have had two sets of guidelines developed: MOOSE (Meta-analysis Of Observational Studies in Epidemiology) and STROBE (STrengthening the Reporting of OBservational studies in Epidemiology).
By: Dr. Ian Stiell