Article Repository

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

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.

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.

Short-Term Topical Tetracaine Is Highly Efficacious for the Treatment of Pain Caused by Corneal Abrasions: A Double-Blind, Randomized Clinical Trial

Disparities in Care: The Role of Race on the Utilization of Physical Restraints in the Emergency Setting

Enhancing citizens response to out-of-hospital cardiac arrest: A systematic review of mobile-phone systems to alert citizens as first responders

October 2020

Effect of a fluid bolus on cardiovascular collapse among critically ill adults undergoing tracheal intubation (PrePARE): a randomised controlled trial

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

Perception of Physician Empathy Varies With Educational Level and Gender of Patients Undergoing Low-Yield Computerized Tomographic Imaging
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).