Evidence-Based Medicine

Does cooling during cardiac arrest improve outcomes, or simply lower temperature? This 2014 appraisal examines a small randomised trial of intra-arrest hypothermia, questioning patient selection, statistical power and surrogate outcomes, while separating the cooling headlines around London’s ‘cool car’ from its broader package of advanced resuscitation care.

Should ultrasound or CT be the first investigation for suspected renal colic? This 2014 appraisal examines a trial comparing emergency physician ultrasound, radiologist ultrasound and CT, focusing on patient outcomes, missed diagnoses, cumulative radiation and the need for additional imaging after the initial test.

Could a follow-up phone call reduce return visits after a child leaves the emergency department? This 2014 appraisal examines a Canadian study in which callers collected concerns without answering them, questioning allocation methods, outcome measurement and whether reattendance alone can tell us that care was better or worse.

An introduction to planning sample size and understanding statistical power, linking effect size, precision and the risks of false positive and false negative results. Worked examples cover continuous outcomes, proportions and diagnostic accuracy studies, helping readers understand the assumptions behind calculations and ask better questions about research.

Could bedside ultrasound improve the assessment of patients with acute breathlessness? This 2014 journal club examines a randomised trial, separating improved diagnostic accuracy from evidence of better patient outcomes and considering how patient selection and reliance on a single ultrasound operator limit the findings.

How should a department prepare for the rare child who needs massive transfusion after trauma? This 2014 journal club examines a small retrospective series, discussing coagulopathy, the limitations of sparse evidence and the importance of planning, shared protocols and simulation for infrequent but time-critical events.