Suggested Journal Club Articles will be posted here as they are made available. The selection of papers for review at Journal Club is overseen by the Chief Residents of the RCPS and CFPC Emergency Medicine training programs and is based on proposals by EM faculty and residents. If you come across a paper you feel merits consideration for review at Journal Club, please use the automated submission form to notify us of this.
Suggested Articles
2022
June 2022
Reassessment of the Role of Race in Calculating the Risk for Urinary Tract Infection: A Systematic Review and Meta-analysis
Submitted by: Dr. Qadeem Salehmohamed
Rationale: UTI is a common pediatric presentation to emergency departments. Tools such as UTI calc hugely influence how we test for UTIs. Previously race was an important variable considered in this clinical tool. However, the tool has recently been revised to remove race as a variable. Discussion around this article can focus not only on how we derive, use and validate clinical decision tools, but also on how we interact with race in our emergency departments.
May 2022
Use of tranexamic acid in major trauma: a sex-disaggregated analysis of the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH-2 and CRASH-3) trials and UK trauma registry (Trauma and Audit Research Network) data
Submitted by: Dr. David Barbic
Rationale: Supports existing evidence that TXA is beneficial for mortality in trauma, and highlights important differences in care provision by sex.
April 2022
Ketamine for the acute treatment of severe suicidal ideation: double blind, randomised placebo controlled trial
Submitted by: Dr. David Barbic
Rationale: We barely study or review mental health and yet is is a huge component of our jobs. Nice RT on a a potentially practice changing therapy that we might be able to perform in the ED.
February 2022
Diagnosis of deep vein thrombosis with D-dimer adjusted to clinical probability: prospective diagnostic management study
Submitted by: Dr. Daniel Ting
Rationale: Clinical probability adjusted D dimer rule that may reduce need for DVT ultrasounds; Similar to PeGED study for PE; Canadian author group
Intracranial hemorrhage after head injury among older patients on anticoagulation seen in the emergency department: a population-based cohort study
Submitted by: Dr. Daniel Ting
Rationale: May help reduce CT head imaging for patients on DOAC who suffer minor head trauma.
Oral Nirmatrelvir for High-Risk, Non-hospitalized Adults with COVID-19
Submitted by: Dr. Frank Scheuermeyer
Rationale: Practice-changing article finally published.
January 2022
Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism: A Randomized Clinical Trial
Submitted by: Dr. Brandon Evtushevski
Rationale: Risk stratification for PE in the ED is a large area of interest and receives a lot of airtime. This study evaluates the performance of a combined PE rule-out criteria (PERC) + YEARS (or D-dimer) strategy:
- Cluster randomized, crossover trial using a non-inferiority approach to compare two PE rule out strategies
- Primary outcome was any venous thromboembolism (VTE) at 3 months
- Strategy 1: PERC first. If PERC positive, YEARS with an age-adjusted D-dimer*; CTPA if YEARS positive; no imaging if YEARS negative
- Strategy 2: PERC first. If PERC positive, age-adjusted D-dimer; CTPA if D-dimer ≥ age-adjusted cutoff; no imaging if less than cutoff
- Analyzed 1,217 patients and found 1 patient with VTE at 3 months in the PERC+YEARS group and 5 in the age-adjusted D-dimer group, which was well within the non-inferiority margin; there was a lower imaging rate in the YEARS group as well
- Outcome summary: It appears safe to use a combined PERC plus YEARS or PERC plus D-dimer strategy. It’s safe to use YEARS with an age-adjusted D-dimer. Finally, PERC plus YEARS (with age-adjusted D-dimer) is non-inferior to PERC plus age-adjusted D-dimer alone.
Normally, if one of the YEARS criteria is positive, then the D-dimer threshold goes from an upper limit of 1000 ng/mL down to 500. This study specified it goes from 1000 down to age-adjusted (<50y = 500; ≥50y D-dimer upper limit = age x 10; for example, 610 ng/mL if 61 years old).
Sensitivity of modern multislice CT for subarachnoid haemorrhage at incremental timepoints after headache onset: a 10-year analysis
Submitted by: Dr. Frank Scheuermeyer
Rationale: Anything that decreases LPs would be nice—medium sized case series. Dr Corinne Hohl has worked on the large Jeff Perry studies and will be of value.
Association between delays to patient admission from the emergency department and all-cause 30-day mortality
Submitted by: Dr. Frank Scheuermeyer
Rationale: This is a bit more complicated, so debated putting on the list. However, it is a clear signal that access block is associated with increased mortality. Strongly, strongly consider inviting Dr. Grant Innes (yes, that one) or Dr. Michael Schull to journal club.
The Journal Club 3.0: a qualitative, multi-site study examining a new educational paradigm in the era of open educational resources
Submitted by: Dr. Frank Scheuermeyer
Rationale: What could be better? Dr. Ting led this study about HOW we learn at journal club…. meta, or what? Better invite him!
First Nations status and emergency department triage scores in Alberta: a retrospective cohort study
Submitted by: Dr. Frank Scheuermeyer
Rationale: Systemic under-triage of First Nations patients in Alberta EDs. Consider inviting medical professional who identifies as First Nations (i.e. Dr. Nadine Caron) to assist and be a guest at JC.
Inhaled budesonide in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial
Submitted by: Dr. Frank Scheuermeyer
Rationale: Hey! Maybe something we can do for our semi-sick Covid patients (I know we are all sick of Covid, but it’s still a good study)
Emergency Department Visits During the Postpartum Period: A Canadian Cohort Study
Submitted by: Dr. Frank Scheuermeyer
Rationale: Uncommon topic for JC. Explores potential care gaps during post period.
Cannabis Legalization and Detection of Tetrahydrocannabinol in Injured Drivers
Submitted by: Dr. Frank Scheuermeyer/Dr. Andrew Chang
Rationale: Please invite Jeff!/Done by local researcher, interesting topic with lots of conflicting evidence being published recently. Not a commonly discussed EM topic.
Surgical fixation with K-wires versus casting in adults with fracture of distal radius: DRAFFT2 multicentre randomised clinical trial
Submitted by: Dr. Frank Scheuermeyer
Rationale: Perhaps less of an EM specific paper but encouraging that a careful closed reduction and immobilization may be all that is required for displaced distal radius fractures. Please note that surgical literature is generally of lower quality, so this kind of trial is rare. Maybe invite a friendly orthropod to attend?
Early targeted heart rate aerobic exercise versus placebo stretching for sport-related concussion in adolescents: a randomised controlled trial
Submitted by: Dr. Frank Scheuermeyer
Rationale: Neurology + peds! Consider inviting a paediatrician to this one!
Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation
Submitted by: Dr. Frank Scheuermeyer
Rationale: Debated this one for a while… 1. We never do geriatrics. 2. Geriatrics EM research isn’t great. 3. We get a lot of ED visits for falls. 4. One of the mandates of EM is to keep people OUT of the the ED! 5. Please do not cover economic or secondary outcomes.
Predictive value of clinician “gestalt” in pediatric community-acquired pneumonia
Submitted by: Dr. Frank Scheuermeyer
Rationale: How do we think? How do we make decisions? How good are physicians at estimating outcomes? Consider saving for, say a potential June JC, which is likely coordinated with peds.
Self-obtained vaginal swabs are not inferior to provider-performed endocervical sampling for emergency department diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis
Submitted by: Dr. Frank Scheuermeyer
Rationale: Sounds like a safe and effective patient-centred strategy!
Frailty and adverse outcomes in older adults being discharged from the emergency department: A prospective cohort study
Submitted by: Dr. Frank Scheuermeyer
Rationale: We never do geriatrics. Please change that.
2021
December 2021
Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial
Submitted by: Dr. Brandon Evtushevski
Rationale: While most cases of pediatric pneumonia are viral, it remains difficult to distinguish which children diagnosed with CAP require antibiotics. As a result, amoxicillin will still be prescribed quite a bit for CAP in young children, and earlier studies like the SAFER trial suggest that a shorter duration of treatment is as effective. This study sheds further light on how we might balance antibiotic efficacy while limiting unnecessary exposure that can lead to unwanted side effects and antimicrobial resistance by reducing both dose and duration of amoxicillin treatment for CAP.
November 2021
Repeat head computed tomography for anticoagulated patients with an initial negative scan is not cost-effective
Submitted by: Dr. Frank Scheuermeyer
Rationale: Relatively straightforward article that may assist in the safe early disposition of patients whom we currently monitor and sequentially image.
October 2021
Patient and Hospital Factors Associated With Differences in Mortality Rates Among Black and White US Medicare Beneficiaries Hospitalized With COVID-19 Infection
Submitted by: Dr. Frank Scheuermeyer
Rationale: Retrospective review of Covid-19 patients (with typical limitations for this type of study) showing worse outcomes for some patients.
Racial Bias in Pulse Oximetry Measurement
Submitted by: Dr. Frank Scheuermeyer
Rationale: Ok team, time to do this short, straightforward paper with a clear message.
September 2021
Rapid Agitation Control With Ketamine in the Emergency Department: A Blinded, Randomized Controlled Trial
Submitted by: Dr. Kiran Rikhraj
Rationale: Well done RCT that assesses the efficacy of different medications to control agitation in the ED—something that we frequently encounter, but that there are few RCTs on.
August 2021
Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial
Submitted by: Dr. Frank Scheuermeyer
Rationale: Well designed RT that follows up on the Caputo (Acad Emerg Med 2020) paper reviewed last academic year.
Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study
Submitted by: Dr. Frank Scheuermeyer
Rational: A bit more complicated, especially when comparing to ABCD2 but still worthwhile reading. Consider inviting Dr. Cheung as she is a co-author
Delayed Antibiotic Prescription for Children With Respiratory Infections: A Randomized Trial
Submitted by: Dr. Frank Scheuermeyer
Rationale: Delayed antibiotics–something we often resort to but never really investigated. While this is in a primary care setting, there are likely lessons for us.
Early Convalescent Plasma for High-Risk Outpatients with Covid-19
Submitted by: Dr. Frank Scheuermeyer
Rationale: One of the few Covid RTs conducted in EDs.
Ultra-early tranexamic acid after subarachnoid haemorrhage (ULTRA): a randomised controlled trial
Submitted by: Dr. Frank Scheuermeyer
Rationale: Yet another negative TXA RT started around 2013! It is a well done study, though.
Diagnosis of non-consensus transient ischaemic attacks with focal, negative, and non-progressive symptoms: population-based validation by investigation and prognosis
Submitted by: Dr. Frank Scheuermeyer
Rationale: This article is going to be a bit more challenging. But it introduces the concept of non-consensus TIAs and may make our job more difficult!
The Influence of the Availability Heuristic on Physicians in the Emergency Department
Submitted by: Dr. Frank Scheuermeyer
Rationale: Clever analysis of physician behaviour and biases
Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients The BaSICS Randomized Clinical Trial
Submitted by: Dr. Frank Scheuermeyer
Rationale: Large well conducted trial in a nontraditional setting. One for the ICU keeners!
Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients The BaSICS Randomized Clinical Trial
Submitted by: Dr. Frank Scheuermeyer
Rationale: Not the first RT to look at different fluids in ICU resuscitation but a topic we haven’t covered in a while
Association of Rideshare Use With Alcohol-Associated Motor Vehicle Crash Trauma
Submitted by: Dr. Frank Scheuermeyer
Rationale: Strongly consider asking Jeff Brubacher to have a look at this before-after study of rideshares and impaired driving trauma. Sometimes the best emergency medicine is keeping people out of the ED.
Prehospital Analgesia With Intranasal Ketamine (PAIN-K): A Randomized Double-Blind Trial in Adults
Submitted by: Dr. Frank Scheuermeyer
Rationale: PLEASE. SOMEONE. DO. THIS. It’s easy!!!! and good!!! and your friends did the study!!!!
Outcomes of an Emergency Department Observation Unit–Based Pathway for the Treatment of Uncomplicated Vaso-occlusive Events in Sickle Cell Disease
Submitted by: Dr. Frank Scheuermeyer
Rationale: Before-after study of a pathway managing an illness that disproportionately affects Black patients.
May 2021
Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism
Submitted by: Dr. Kaitlin Stockton
Rationale: While not validated, this is pretty good evidence that we can use d-dimer to help rule out PE in pregnancy, which is a frequent clinical dilemma in the ED. I would be very interested to hear a discussion regarding whether or not we should be changing practice and adopting this algorithm based on this paper.
February 2021
Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source
Rationale: Is dabigatran effective?
January 2021
Bupropion and Naltrexone in Methamphetamine Use Disorder
Rationale: Not many studies looking at this type of devastating addiction. The analysis is a little complicated but manageable.
2020
November 2020
Diagnosing acute aortic syndrome: a Canadian clinical practice guideline
Rationale: A first of its kind potentially practice-changing guideline. Critical to evaluate and review the evidence (or lack thereof) that the guideline-based upon.
October 2020
Diagnosing acute aortic syndrome: a Canadian clinical practice guideline
Rationale: Important CPG, in particular with information and evidence for the role of d dimer. Also has a scoring system, though unvalidated. Would generate interesting discussion on role of CPGs.
September 2020
Lung-Protective Ventilation and Associated Outcomes and Costs Among Patients Receiving Invasive Mechanical Ventilation in the Emergency Department – CHEST
Submitted by: Dr. David Barbic
Rationale: Interesting study.
Perception of Physician Empathy Varies With Educational Level and Gender of Patients Undergoing Low-Yield Computerized Tomographic Imaging
Submitted by: Dr. David Barbic
Rationale: Suggests that patients perceive physicians differently based upon various patient factors. These are uncommon and important data for ED physicians to consider. If choosing this paper, please liaise early with resource person.
Multicenter Validation of an Emergency Department–Based Screening Tool to Identify Elder Abuse
Submitted by: Dr. David Barbic
Rationale: Elder abuse is a common, and under recognized problem. This screening tool has demonstrated strong sensitivity and spec. in multi center validation for accurately detecting elder abuse.
Can Emergency Physicians Accurately Rule Out a Central Cause of Vertigo Using the HINTS Examination? A Systematic Review and Meta‐analysis
Submitted by: Dr. David Barbic
Rationale: HINTS exam is a helpful adjunct to investigate vertigo but the results of this meta-analysis suggest it lacks the accuracy to be used alone.
Prevention of benign paroxysmal positional vertigo with vitamin D supplementation: A randomized trial
Submitted by: Dr. Qadeem Salehmohamed
Rationale: BPPV is a common problem in the ED with few satisfying therapies. Epply maneuvers are done inconsistently between different clinicians. This may be a drug therapy which could help these patients.
July 2020
Outcome of immediate versus early antibiotics in severe sepsis and septic shock: a systematic review and meta-analysis.
Submitted by: Dr. Frank Scheuermeyer
Rationale: Rapid administration of antibiotics has been encouraged and is in some cases a mandatory quality marker. Strongly consider Dr Hohl or Dr Moe for assistance with this interesting manuscript, which may change both practice and QI standards.
Development and validation of the quick COVID-19 severity index (qCSI): a prognostic tool for early clinical decompensation
Submitted by: Dr. Frank Scheuermeyer
Rationale: Obviously a useful tool for emergency physicians, internists, and intensivists.
Timing of initiation of renal replacement therapy in acute kidney injury.
Submitted by: Dr. Frank Scheuermeyer
Rationale: Canadian-led study that is important for critically ill patients, including those boarded in the ED. Analysis is straightforward and this is a topic we do not commonly discuss.
Seroprevalence of antibodies to SARS-CoV-2 in 10 sites in the United States March 23 – May 12, 2020.
Submitted by: Dr. Frank Scheuermeyer
Rationale: There are many seroprevalence studies. First large US study, and illustrates an important point with these studies, some of which have been used for non-medical purposes.
Race, postoperative complications, and death in apparently healthy children.
Submitted by: Dr. Frank Scheuermeyer
Rationale: First study of healthy children and complications, stratified by ethnocultural background. Methods straightforward and demonstrates substantially different outcomes for different backgrounds. This kind of study is critical to understanding outcomes in marginalized populations and will be mandatory at some point this academic year.
HALT-IT trial in Lancet
Rationale: I received this article suggestion from Dr. Mario Francispragasam. He indicated he thought it was a good article based on it being practice changing with good adherence to scientific process.
March 2020
Adjunct Ketamine Use in the Management of Severe Ethanol Withdrawal
Submitted by: Holly Sherman
Rationale: Consideration for the use of ketamine infusion in the agitated alcohol withdrawal group – especially useful in those are are acutely dangerously agitated. Ketamine is already being used in the management of the severely agitated in the ED with benefits of less respiratory depression and immediate symptom control.
Use of prophylactic antibiotic in preventing complications for blunt and penetrating chest trauma requiring chest drain insertion: a systematic review and meta-analysis
Submitted by: Dr. David Barbic
Rationale: Very relevant to EM practice, probably the best evidence so far on this topic.
January 2020
Effect of Rocuronium vs Succinylcholine on Endotracheal Intubation Success Rate Among Patients Undergoing Out-of-Hospital Rapid Sequence Intubation A Randomized Clinical Trial
Submitted by: Dr. Riyad Abu-Laban
Rationale: This is a “hot” topic in the airway management world, with a paucity of high level evidence to support the various opinions that have been put forward. The paper is a major contribution, but has some methodologic limitations that make its interpretation and application potentially challenging and controversial. This paper has already generated significant discussion among the VGH ED physician group, and would be good to bring forward to Journal Club for the awareness of residents and a broader collective appraisal. Two physicians I’d suggest the Chief Resident directly invite and encourage to attend the Vancouver area JC, if this is selected as an article, are Corinne Hohl (who circulated the paper to the VGH group in late December, and recently discussed another paper on this topic at VGH EM Rounds) and Jan Trojanowski (who has significant EMS and critical care expertise/experience, including a recent LOA working for the London Helicopter EMS service, and who brought some important perspectives forward during the VGH group discussion and argued that this paper doesn’t in fact add much to the literature on this topic).