Skip to main content

Randomized clinical trial of antibiotics in acute uncomplicated Diverticulitis


Methodology: 3/5          
Usefulness: 3/5
Chabok A, Påhlman L, Hjern F, Haapaniemi S, Smedh K; AVOD Study Group.
Br J Surg. 2012 Apr;99(4):532-9


An open label multicenter RCT from Sweden comparing usual antibiotic treatment versus no antibiotics (IV fluids only) in the treatment of acute uncomplicated diverticulitis showed that there was no statistical difference in rate of complications while in hospital or in a 12 month follow-up period (1.0% vs. 1.9% complication rate in Abx vs no Abx group P=0.302). Due to study limitations such as the lack of blinding, possible selection bias for milder cases and lack of power, JC attendees were not convinced to yet change our current practice.  
By: Dr. Lisa Harman
(Presented January 2013)

Epi Lesson:
Open label trials may be promoted as pragmatic trials but a lack of blinding to treatment allocation is a fundamental threat to internal validity. Blinding reduces ascertainment bias (the likelihood of differential assessment of outcome). It is not always possible to undertake blinding in a RCT. But a critical reader will ask whether it was possible to blind outcome assessors. If the answer is yes, then this leads to concern about the validity of RCT results. 
By: Dr. Lisa Calder

Comments

Popular posts from this blog

Tips for Success in your Emergency Medicine Rotation

Our wonderful medical students are preparing to start their first clinical rotations. With this in mind here are some of the top tips for success in your EM rotation
1)Be On Time – show up to your shifts on time, better yet 5 minutes early.That first impression is immensely important.
2)Introduce yourself to the team - “Hi my name is John Doe, I am the medical student on shift today” introduce yourself to the attending, residents, nurses, etc.You will be called on a lot more to help when there is something interesting going on if they know your name.
3)Be goal-oriented – have a goal for each shift, whether it’s a procedure or a type of presentation to see.
4)Don’t just stand there, do something – whenever there is a trauma or code, come to the bedside.Get gowned up for traumas and pay attention.Help with things that are within your scope of practice: chest compressions, moving patient, cardioversion
5)Don’t just stand there, do nothing – there are times in medicine when the best thing to d…

The Canadian Syncope Risk Score

Guest post by Dr. Venkatesh Thiruganasambandamoorthy.
Syncope is an commonly encountered problem in Emergency Medicine, with the potential for significant morbidity and mortality to patients. Unfortunately, to date, there have not been any reliable decision tools or instruments to help us in our assessment of the syncope patient.  This week, Venkatesh Thiruganasambandamoorthy and colleagues at the Ottawa Hospital have published an new Canadian Syncope Risk Score to identify patients at risk of serious adverse events, published in CMAJ.1 Here, Dr. Venk helps provides some further insight and potential utilization of the risk score, he may also be heard discussing this rule on the March edition of Canadian EMRAP.


BackgroundSyncope constitutes 1% of Emergency Department (ED) visits, and approximately 10% of these patients will have serious underlying conditions causing syncope (arrhythmia, MI, serious structural heart disease, pulmonary embolism, subarachnoid or severe hemorrhage). Alarmin…

2014 Canadian Guidelines for AF Management: Part 1: Introduction and CCS “CHADS-65” Algorithm

by Ian Stiell MD @EMO_Daddy














In this and subsequent postings we will discuss the latest recommendations for ED management of atrial fibrillation (AF) as presented in the newly published 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. The Guidelines PDF can be downloaded from the CCS website at 2014 Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation
The 2014 Focused Update uses the GRADE system of evidence evaluation as was the case in the comprehensive 2010 AF Guidelines and the 2012 Update. The CCS AF Guidelines Panel is comprised of Canadian cardiologists plus physicians from internal medicine, family medicine, neurology, and emergency medicine. This 2014 Update provides evidence review and recommendations for 8 aspects of AF care, including ED Management (written by myself and Dr. Laurent Macle of the Montreal Heart Institute). The 2014 Update focuses on advances in oral anticoagulant (O…