Journal Club: Arrests and Ankles at Astor’s

It was a smaller than normal showing at Journal Club at Jack Astor’s but the discussion was better than the nachos…and they were awesome. This week’s edition of Journal Club featured two articles. The commentary below, written by Eve, was staff reviewed by Tim!

Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest

by Peter Kudenchuck et al. published recently in the New England Journal of Medicine. 

Kathleen and Hadi chose this new paper and led the critical appraisal. The discussion was unbelievably rich. Summarizing the complexity is really beyond the scope of this blog post but suffice it to say, we agreed that we will continue to use antiarrythmics in arrests. Instead of going through the paper, which is worth taking the time to do when you get the chance, I thought I would draw attention to one research principle that came up in discussion so that you can keep it in mind when reading the article yourself! I want to credit all the folks who were at journal club for highlighting this, and many other, important points. Collaborative intelligence, especially when Dan’s insights are included,  is pretty neat.

Trials are designed to demonstrate superiority, equivalence or non-inferiority. Each of these trial types require different designs, have different outcomes, use different statistical methods and allow different conclusions to be drawn. The article we discussed was designed as a superiority trial but the authors’ conclusions were stated in equivalency or “no difference” terms which is not a true representation of how the original question was approached. If you are interested in learning more about this difficult to grasp concept, I often find myself having to come back to this article explaining the idea (interestingly it was also published in NEJM).

Journal Club April 19

If you weren’t able to make it to journal club, and even if you did, I’d encourage you to chat about this paper over the next coming days and weeks, there’s lots of food for thought.

Radiographic-Negative Lateral Ankle Injuries in Children: Occult Growth Plate Fracture or Sprain?

by Boutis K. et al (including our very own Dr. Brison) published in JAMA Paediatrics in January 2016.

Erin and Tim chose to look at an article which challenges the dogma that “kids don’t sprain ankle ligaments they break ankle bones”. Again it is worth reading this article. When you do, you’ll find that the rate of Salter 1 injuries in kids with inversion injuries with normal plain radiographs is very low (~3%) and those kids do very well with simple management.

For the junior residents, in case you are like me and need a reminder of the Salter-Harris fracture classification check out this great radiopedia article.

Next time you are working with Dr. Brison, ask him about this paper and pick his brain about ankles in general. I can guarantee you will learn something!

 

Look forward to seeing you at the next JC. 

Author: Eve Purdy

PGY2 in Emergency Medicine with added interests in online learning environments, paediatrics and anthropology. Outside of the department she strums a guitar occasionally and dog sits as often as she can.

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