Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial

Journal Club Summary Methodology Score: 4/5  Usefulness Score:  3.5/5 Aujesky D, et al. Lancet. 2011 Jul 2;378(9785):41-8. Abstract Link   This open label, randomized, un-blinded, multi-centered trial compared inpatient vs. outpatient treatment of low-risk PE showed that outpatient management is non-inferior with respect to endpoints of recurrent VTE, major bleeding, and mortality. JC attendees felt the methodology was strong; however, were less […]

Fever Control Using External Cooling in Septic Shock: A Randomized Controlled Trial

Journal Club Summary Methodology Score: 2.5/5               Usefulness Score: 2/5   Schortgen F, et al. Am J Respir Crit Care Med. 2012 May 15;185(10):1088-95 Full Article    This randomized, non-blinded trial found in an ICU population that external cooling in febrile patients with septic shock resulted in a 50% decrease in vasopressor requirements at 12 and 24 hours, however, their data was […]

A Randomized Trial of Colchicine for Acute Pericarditis

Journal Club Summary Methodology Score: 4.5/5                           Usefulness Score: 4.5/5   Imazio M, et al. ICAP Investigators. N Engl J Med. 2013 Oct 17;369(16):1522-8. Article Link   This multicentre double-blind RCT found that a 3 month course of low-dose colchicine is superior to placebo in reducing recurrence rates after first-episode pericarditis (NNT 4, ARR 0.2, RRR 0.56). The group felt that colchicine should […]

Sensitivity of Bedside Ultrasound and Supine Anteroposterior Chest Radiographs for the Identification of Pneumothorax After Blunt Trauma

Journal Club Summary Landmark Series Methodology Score: 4/5                  Usefulness Score: 4/5   Wilkerson RG, Stone MB. Acad Emerg Med. 2010 Jan;17(1):11-7.   Article Link 
 This evidence-based literature review of four prospective observational studies identified that bedside ultrasound had excellent sensitivity (86-98%) especially compared to supine AP xray (28-75%) for identifying pneumothorax after blunt trauma.  The group discussed that this […]

Red flags to screen for malignancy and fracture in patients with low back pain: systematic review

Journal Club Summary Methodology Score: 2.5/5               Usefulness Score: 2.5/5   Downie A, et al. BMJ 2013;347:f7095 Article Link   This Cochrane review of the diagnostic accuracy of red flags for fracture or malignancy in patients with low back pain in multiple settings found that corticosteroid use (+LR 4-48.5), severe trauma (+LR 3.4-10), presence of overlying contusion (+LR 31.1, single study), or […]

Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial

Journal Club Summary Landmark Series Methodology Score: 4/5                  Usefulness Score: 4/5   CRASH-2 trial collaborators Lancet. 2010 Jul 3;376(9734):23-32. Article Link This large RCT assessed the effect of early administration of tranexamic acid to trauma patients and revealed statistically significant results in favour of TXA for the reduction of overall death and death from bleeding without significant adverse effects (0.91 […]

Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomised controlled trial

Journal Club Summary Methodology Score: 4/5                  Usefulness Score: 2/5   Bateman DN, et al. Lancet. 2014 Feb 22;383(9918):697-704 Article Link   This 2×2 factorial, intention to treat, randomized controlled trial of paracetamol overdose showed a modified 12 h NAC protocol vs 20.25h protocol and ondansetron pre-treatment vs placebo causes less nausea and vomiting .  It is an interesting precursor to […]

Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage

Journal Club Summary Methodology Score: 4/5                  Usefulness Score: 2/5   INTERACT2 Investigators. N Engl J Med. 2013 Jun 20;368(25):2355-65.   Article Link   This large multicentre, partially blinded RCT compared aggressively lowering SBP to <140 vs. standard care in acute non-traumatic intracerebral hemorrhage and found no significant difference in rates of death or major disability between the two groups, although […]

Efficacy of pain control with topical lidocaine–epinephrine–tetracaine during laceration repair with tissue adhesive in children: a randomized controlled trial

Journal Club Summary Methodology Score: 4.5/5                  Usefulness Score: 3.5/5 Harman S, Zemek R, Duncan MJ, Ying Y, Petrcich W. CMAJ. 2013 Sep 17;185(13):E629-34.   Article Link   This study was a double blind RCT which demonstrated that using topical LET on minor lacerations before wound closure with tissue adhesive, reduced pain associated with the procedure as a primary outcome, and, […]

Bedside focused echocardiography as predictor of survival in cardiac arrest patients: a systematic review.

Journal Club Summary Methodology Score: 4/5                  Usefulness Score: 4/5   Blyth L, Atkinson P, Gadd K, Lang E. Acad Emerg Med. 2012 Oct;19(10):1119-26. Article Link   This systematic review of 8 studies found that when transthoracic ultrasound is performed during cardiac arrest, the absence of cardiac activity indicates a low but not zero likelihood that a patient will experience ROSC […]