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Showing posts from July, 2013

Ability of emergency ultrasonography to detect pediatric skull fractures: a prospective, observational study

Methodology Score: 3.5/5                           Usefulness Score: 3.5/5 Parri N, Crosby BJ, Glass C, Mannelli F, Sforzi I, Schiavone R, Ban KM. J Emerg Med.2013 Jan;44(1):135-41.
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This single center prospective study of 55 children found that with minimal training, emergency physicians could detect pediatric skull fractures with a sensitivity of 100% (95% CI 88.2-100%) and a specificity of 95% (95% CI 75.0-99.9%) as compared to CT scan. The group discussed that if reproduced with larger studies, this study could potentially change management for infants under 24 months of age where ruling out a skull fracture by ultrasound could prevent them from needing to undergo a CT Scan.   By: Dr. Mélissa Langevin (Presented April 2013)
Epi Lesson – The Importance of Specificity
While ED physicians are appropriately concerned that tests used to rule out serious illness have very high sensitivity, we also must be concerned about specificity. If a screening test has a low specificity, it will…

Epinephrine and Dexamethasone in Children with Bronchiolitis

Landmark Series Methodology Score: 4.5/5  Usefulness Score: 4/5 Plint AC, Johnson DW, Patel H, Wiebe N, Correll R, Brant R, Mitton C, Gouin S, Bhatt M, Joubert G, Black KJ, Turner T, Whitehouse S, Klassen TP; Pediatric Emergency Research Canada (PERC). N Engl J Med.2009 May 14;360(20):2079-89
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This prospective, multicenter, double-blind randomized trial of 800 infants found a synergistic effect between epinephrine and dexamethasone for the treatment of acute bronchiolitis and that, together, they lower admission rates at seven days, although the primary analysis was not significant after adjustment (RRR of 35%, RR 0.64, [95% CI 0.37-1.15]). The group agreed that although an important effect was noted, there are still some issues with the dosage of dexamethasone used and therefore the optimal dosing of both epinephrine and dexamethasone would have to be further examined. By: Dr. Qamar Amin (Presented April 2012)

Epi Lesson – Adjustment Analyses in Randomized Trials
Clinical trials de…