Emergency Cricothyroidotomy: A Randomized Crossover Trial Comparing Percutaneous Techniques: Classic Needle First Versus “Incision First”

Journal Club Summary  Methodology Score: 3/5                       Usefulness Score: 2/5 Kanji H, Thirsk W, Dong S, Szava-Kovats M, Villa-Roel C, Singh M, Rowe BH. Acad Emerg Med. 2012 Sep;19(9):E1061-E1067.   Article Link   This was a randomized crossover trial comparing needle (seldinger) Cricothyroidotomy (NF) with a new technique that utilizes the initial surgical vertical incision to find the cricothyroid membrane before […]

Accuracy of single-pass whole-body computed tomography for detection of injuries in patients with major blunt trauma

Journal Club Summary  Methodology: 3/5                       Usefulness: 3/5   Stengel D, Ottersbach C, Matthes G, Weigeldt M, Grundei S, Rademacher G, Tittel A, Mutze S, Ekkernkamp A, Frank M, Schmucker U, Seifert J. CMAJ. 2012 May 15;184(8):869-76. Article Link   In this study by Stengel et al., the initial pan-scan findings of 1000 consecutive blunt trauma patients were evaluated and compared […]

Dopamine versus norepinephrine in the treatment of septic shock: a meta-analysis

Journal Club Summary Methodology Score: 3.5/5 Usefulness Score: 4/5 De Backer D, Aldecoa C, Njimi H, Vincent JL. Crit Care Med. 2012 Mar;40(3):725-30. Article Link This meta-analysis of 6 trials found that in patients with septic shock, dopamine administration was associated with greater mortality (RR 1.12, 95% CI 1.01-1.20; P=0.035) and a higher incidence of arrhythmic events (RR 2.34) compared to […]

Electrocardiographic differentiation of early repolarization from subtle anterior ST-segment elevation myocardial infarction

Journal Club Summary Methodology Score: 3/5 Usefulness Score: 2/5 Smith SW, Khalil A, Henry TD, Rosas M, Chang RJ, Heller K, Scharrer E, Ghorashi M, Pearce LA. Ann Emerg Med. 2012 Jul;60(1):45-56.e2. Epub 2012 Apr 19. Pub Med Link   This retrospective cohort study of anterior STEMI and Benign Early Repolarization (BER) patients derived and validated a mathematical combination of 3 ECG criteria (R-wave […]

Performance of 4 clinical decision rules in the diagnostic management of acute pulmonary embolism: a prospective cohort study

Journal Club Summary  Methodology Score: 3/5  Usefulness Score: 3/5 Douma RA, Mos IC, et al. Prometheus Study Group. Article Link This European study directly compared four clinical decision rules in combination with d-dimer testing to exclude PE without the need for CT and found similar performance with very high sensitivity for all four; the authors concluded that simplified Wells or […]

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, […]