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

March 7, 2020
Adjunct Ketamine Use in the Management of Severe Ethanol Withdrawal
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.

March 3, 2020
Use of prophylactic antibiotic in preventing complications for blunt and penetrating chest trauma requiring chest drain insertion: a systematic review and meta-analysis.
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
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).

 

December 2019

Diagnosis of Pulmonary Embolism with D-Dimer adjusted to Clinical Probability – Dr. Larissa Hattin

Rationale: A prospective study in which pulmonary embolism was considered to be ruled out without further testing in outpatients with a low C-PTP and a d-dimer level of less than 1000 ng per milliliter or with a moderate C-PTP and a d-dimer level of less than 500 ng per milliliter.
Gives different D Dimer cut-off values depending on the risk stratification using Well’s criteria.

 

October 2019

Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial – D. Ting
Rationale:
– Clinically important topic with tons of scientific and social media attention
– High level of evidence, multicenter, international RCT with >12,000 patients
– methodological discussion of a statistically negative trial for the primary outcome but important signals/subgroup outcomes
– Potentially practice-changing

 

September 2019

Defining the criteria for intubation of the patient with thermal burns – L. Hattin
Rationale: Recent studies demonstrate that burn patients are undergoing unnecessary intubations. This article sought to determine the clinical criteria that predict intubations with benefit to the patient.

Ketamine as a Rapid Sequence Induction Agent in the Trauma Population: A Systematic Review – L. Hattin
Rationale: Ketamine is commonly used in the hemodynamically unstable trauma patient although it has been associated with side effects. This review sought to investigate whether ketamine should be preferred over other induction agents for RSI in trauma patients.

Association of Blood Component Ratios with 24-hr Mortality in Injured Children Receiving Massive Transfusion – L. Hattin
Rationale: One of the main concerns for pediatric trauma is hypovolemia secondary to massive hemorrhage. This paper would be interesting to see if we need to consider other ratios in our massive transfusion protocol specific to pediatrics.

Exposure to Media Information About a Disease Can Cause Doctors to Misdiagnose Similar-Looking Clinical Cases – J. Powell
Rationale: I haven’t seen any medical education articles and this one offers a unique perspective on cognitive (association) bias – thinking a diagnosis is more likely because you have recently seen it, or read about it. What’s unique is that they recreated this bias in residents and then reversed it using structured reflection – which offers an easy strategy of structured reflection on a case to correct and reverse these types of errors in system 1 thinking.

 

July 2019

Association Between Time to Treatment With Endovascular Reperfusion Therapy and Outcomes in Patients With Acute Ischemic Stroke Treated in Clinical Practice – F. Scheuermeyer
Rationale: fairly straightforward study regarding stroke care.

 

June 2019

A Prediction Model to Identify Febrile Infants ≤60 Days at Low Risk of Invasive Bacterial Infection – F. Scheuermeyer

 

May 2019

Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis – F. Scheuermeyer
This is complex but potentially very important towards understanding sepsis and why so many trials are “negative” and why the results from trial may not always apply.

Prehospital Analgesia With Intranasal Ketamine (PAIN-K): A Randomized Double-Blind Trial in Adults – F. Scheuermeyer
Rationale: Prehospital RT. Make sure to invite Gary!!!

Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke – F. Scheuermeyer
Rationale: Enlarges thrombolysis window in stroke to 9 hours.

Buprenorphine/naloxone induction in a Canadian emergency department with rapid access to community-based addictions providers – F. Scheuermeyer
Rationale: Small study from Canada that provides some data for buprenorphine to go programs. Invite Jess Moe or Andy Kestler please.

Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism – A. Abdalvand, F. Scheuermeyer
Rationale: The YEARS algorithm for PE has been done before but this may add value since it is in pregnant patients. Challenging paper but useful results.

 

Apr. 2019

Acute kidney injury following contrast media administration in the septic patient: A retrospective propensity-matched analysis. – E. Genuis
Rationale: More great studies re CIN! Maybe some more will put the final nail in the coffin on this.

 

Mar. 2019

Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation – D. Harris

Effect of patient-centered transitional care services on clinical outcomes in patients hospitalized for heart failure – F. Scheuermeyer
Rationale: patient-cantered models, and transitions of care are both very current topics. poorly explored in EM. Although this in on the inpatient ward, has important lessons for emergency medicine as well. Also: good study design

Antibiotic management of urinary tract infection in elderly patients in primary care and its association with bloodstream infections and all cause mortality: population based cohort study. – F. Scheuermeyer
Rationale: some guidelines have recommended withholding antibiotics in select cases. We don’t often review population level statistics, and this kind of analysis would likely not be possible with a randomized trial or smaller observational study.

Efficacy and safety of a monthly buprenorphine depot injection for opioid use disorder: a multicenter, randomized, double-blind placebo-controlled trial. – F. Scheuermeyer
Rationale: Pragmatic trial comparing two methods of administering opioid agonist therapy.

Is Buddy Taping as Effective as Plaster Immobilization for Adults With an Uncomplicated Neck of Fifth Metacarpal Fracture? A Randomized Controlled Trial
Rationale: Small study with some method issues BUT in an area we rarely cover and could change practice. If a resident wishes to cover this, consider discussing with a hand specialist or better yet, have them attend JC in person or via phone.

Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock
The ANDROMEDA-SHOCK Randomized Clinical Trial – F. Scheuermeyer
Rationale: Randomized trial to explore whether we truly need to collect serial lactate measurements in critically ill patients.

 

Feb. 2019

HEART score risk stratification of low-risk chest pain patients in the emergency department: a systematic review and meta-analysis – F. Scheuermeyer
Rationale: We rarely assess systematic reviews/meta-analyses although they are becoming very, very popular; very hot topic; clinically relevant; remember to invite Corinne or Jess for discussion.

Older blood is associated with increased mortality and adverse events in massively transfused trauma patients: secondary analysis of the PROPPR trial – F. Scheuermeyer
Rationale: Interesting topic, good methodology, good CQI project, also potential ethical questions regarding stored / older blood, consider inviting Heather Lindsay from CQI viewpoint.

Road Safety Impact of Increased Rural Highway Speed Limits in British Columbia, Canada (PDF download) – F. Scheuermeyer
Rationale: tough methods but great study impacting public health/prevention/government policy in a way that we do not often see emergency research contribute. Be sure to invite Jeff, and better yet assign a more experienced resident and have Jeff be the resource person at least for that study.

Multicenter trial of a combination probiotic for children with gastroenteritis – F. Scheuermeyer
Rationale: Canadian-led RT debunks a fairly common practice. Straightforward; a junior resident could present without much challenge.

A systematic review and meta-analysis of ketamine as an alternative to opioids for acute pain in the emergency department – F. Scheuermeyer
Rationale: Ketamine starting to become more accepted, should generate good discussion despite not that many relevant papers, perhaps invite Corinne or Jess.

Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With Undifferentiated Hypotension? An International Randomized Controlled Trial From the SHoC-ED Investigators – F. Scheuermeyer
Rationale: One of the best ultrasonography studies ever. Strongly consider inviting Dan Kim or Oron Frenkel to discuss.