Association Between helicopter vs Ground Emergency Medical Services and Survival for Adult with Major Trauma

  Journal Club Summary Methodology Score: 3/5           Usefulness Score: 2.5/5   Galvagno SM Jr, Haut ER, Zafar SN, Millin MG, Efron DT, Koenig GJ Jr, Baker SP, Bowman SM, Pronovost PJ, Haider AH. JAMA 2012 Apr 18;307(15):1602-10. Article Link   This retrospective cohort study of 223,475 patients in the U.S. National Trauma Data Bank used multivariate statistical analyses including propensity scoring […]

The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis.

Journal Club Summary Landmark Series Quant EC, et. al 2009;339:b3354. Methods: 4/5  Usefulness: 4/5  Article Link This high quality meta-analysis demonstrated that the addition of antivirals to steroids did not result in any additional benefit in achieving at least partial facial muscle recovery for Bell’s palsy when compared to steroids alone. JC attendees noted that these conclusions were in contrast to […]

Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage.

Journal Club Summary Landmark Series Mayer SA, Brun NC, Begtrup K, Broderick J, Davis S, Diringer MN, et al. N Engl J Med. 2008 May 15;358(20):21 27–37.  Article Link This industry sponsored, international multicentre RCT involved 841 patients with acute ICH and found that Factor VII was associated with a reduced growth in hematoma size but no improvement in survival or […]

Hydrocortisone therapy for patients with septic shock.

Journal Club Summary Landmark Series Sprung CL, Annane D, Keh D, Moreno R, Singer M, Freivogel K, et al. N Engl J Med. 2008 Jan.10;358(2):111–24.  Article Link This European multicentre RCT compared hydrocortisone to placebo for 499 ICU patients with septic shock and found no difference in mortality despite quicker resolution of shock with hydrocortisone; the hydrocortisone patients had more […]

Does this adult patient have septic arthritis?

Journal Club Summary Landmark Series Margaretten ME, Kohlwes J, Moore D, Bent S. JAMA. 2007Apr.4;297(13):1478–88.  Article Link This systematic overview from the excellent JAMA series reviewed the relatively weak evidence regarding assessment of patients with suspected septic arthritis. JC attendees found the odds ratios for clinical findings to be useful (high risk – age 80, recent joint surgery, joint prosthesis, […]

Randomized, Controlled Trial of Acetaminophen, Ibuprofen, and Codeine for Acute Pain Relief in Children With Musculoskeletal Trauma.

Journal Club Summary Landmark Series Clark E, Plint AC, Correll R, Gaboury I, Passi B. A  Pediatrics. 20 07Mar.1;119(3):460–7. Article Link This high quality RCT by local investigators rigorously compared acetaminophen, ibuprofen and codeine analgesics among children in the ED with MSK trauma and found ibuprofen to be statistically and clinically significantly superior on a self-reported validated visual acuity pain scale. JC […]

How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis?

Journal Club Summary  Landmark Series Straus SE, Thorpe KE, Holroyd-Leduc J. JAMA. 2006Oct.25;296(16):2012–22.  PubMed Link This systematic literature review and meta-analysis in the Rational Clinical Examination series found a non-significant trend towards less post-LP headache with the use of atraumatic needle and mobilization post-LP. Reinsertion of the stylet significantly reduced post-LP headache and CSF wbc>500 and lactate>3.5mmol/L accurately diagnosed bacterial […]

Safety and Efficacy of Hydromorphone as an Analgesic Alternative to Morphine in Acute Pain: A Randomized Clinical Trial

Journal Club Summary  Landmark Series Andrew K Chang, Polly E Bijur, Robert H Meyer, Mark K Kenny, Clemencia Solorzano, and E John Gallagher PubMed Link   This U.S. randomized trial in ED adults with severe pain found similar effectiveness for intravenous hydromorphone [0.015 mg/kg] and iv morphine [0.1 mg/kg]. This was a well-done study and many JC attendees professed their […]

Laryngeal View During Laryngoscopy: A Randomized Trial Comparing Cricoid Pressure, Backward-Upward-Rightward Pressure, and Bimanual Laryngoscopy

Journal Club Summary Landmark Series Levitan RM, Kinkle WC, Levin WJ, Everett WW. Ann Emerg Med. 2006 Jun.;47(6):548–55. PubMed Link This U.S. study evaluated manipulation techniques for direct laryngoscopy during endotracheal intubation in 1,530 comparisons performed by 104 physicians in fresh cadavers. Bimanual laryngoscopy improved laryngeal view compared to cricoid pressure, backward-upward-rightward pressure, and no manipulation. JC attendees expressed considerable support […]