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.

By: Dr. Jessica McCallum

Epi Lesson

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


  • Hans Rosenberg

    Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.

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