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Showing posts from December, 2016

Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope.

Journal Club Summary Methodology Score:4.5/5 Usefulness Score:4/5
Thiruganasambandamoorthy V, et al. CMAJ. 2016 Sep 6;188(12):E289-98 Full Article
This large multicenter prospective ED syncope study derived a methodologically robust risk tool for prediction of 30-day serious adverse events after ED disposition. This risk score will aid in ED management of patients: those at higher-risk require further management (thorough assessment and investigations including outpatient cardiac monitoring); and once validated the tool can aid in identification and quick disposition of low-risk patients.   By: Dr. Robert Ohle
(Full Disclosure: Dr. Thiruganasambandanmoorthy is an EMOttawa staff and was the lead author of the study. For a full explanation of the Canadian Syncope Risk Scale from the author see this post
Epi lessonApproach to Decision Rule Development In this era of clinical decision tools being developed for almost anything, we need to think will a clinical decision tool be helpful and how to…

Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope.

Journal Club SummaryMethodology Score: 3.5/5               Usefulness Score:  2/5
Prandoni P, et al. N Engl J Med. 2016 Oct 20;375(16):1524-1531.
Full Article
This cross-sectional multi-center study of Italian patients admitted after an ED presentation for syncope found a 17.1% PE rate among admitted patients and 3.8% among all-comers to the ED. These results are in stark contrast to current perceptions and measured data surrounding prevalence and outcomes with syncope and PE. The group felt the differences are due in large part to spectrum bias and in part due to over-diagnosis and incidental findings. Studies in populations similar to ours would be required to change current practice. 
By: Dr. Michael Ho
Epi lessonBy: Dr. Venkatesh Thiruganasambandamoorthy Spectrum Bias: For clinicians the probability and the seriousness of underlying condition(s) previously reported dictates how aggressively they investigate to identify the serious condition. Seriousness depends both on the condition (e.g…

Blood, Salt, and CTs: An Update in Trauma for 2016