Template:Journal Club Review - Revision history

Danbot: Add noinclude and status=Template to prevent incorrect categorization

2026-03-21T22:15:36Z

Add noinclude and status=Template to prevent incorrect categorization

← Revisión anterior		Revisión del 22:15 21 mar 2026
Línea 1:		Línea 1:
			<noinclude>This is a blank template for creating new Journal Club articles. Copy this template to create a new EBQ page.</noinclude>
	{{JC info		{{JC info
	\| title=		\| title=
Línea 13:		Línea 14:
	\| fulltexturl=		\| fulltexturl=
	\| pdfurl=		\| pdfurl=
			\| status = Template
	}}		}}
	==Clinical Question==		==Clinical Question==

Mholtz: Reverted edits by Panosiaa (talk) to last revision by Ostermayer

2017-07-05T21:55:18Z

Reverted edits by Panosiaa (talk) to last revision by Ostermayer

← Revisión anterior		Revisión del 21:55 5 jul 2017
Línea 4:		Línea 4:
	\| expansion=		\| expansion=
	\| published=		\| published=
	\| author=		\| author=
	\| journal=		\| journal=
	\| year=		\| year=
Línea 15:		Línea 15:
	}}		}}
	==Clinical Question==		==Clinical Question==


	==Conclusion==		==Conclusion==


	==Major Points==		==Major Points==


	==Study Design==		==Study Design==

	==Population==		==Population==


	===Patient Demographics===		===Patient Demographics===
	===Inclusion Criteria===		===Inclusion Criteria===


	===Exclusion Criteria===		===Exclusion Criteria===


	==Interventions==		==Interventions==

	==Outcomes==		==Outcomes==


	===Primary Outcome===		===Primary Outcome===


	===Secondary Outcomes===		===Secondary Outcomes===



	===Subgroup analysis===		===Subgroup analysis===



	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==

	==External Links==		==External Links==

Panosiaa at 20:46, 5 July 2017

2017-07-05T20:46:09Z

← Revisión anterior		Revisión del 20:46 5 jul 2017
Línea 1:		Línea 1:
	{{JC info		{{JC info
	\| title= ~~Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure.~~		\| title=
	\| abbreviation=		\| abbreviation=
	\| expansion=		\| expansion=
	\| published=		\| published=
	\| author=~~Nagdev AD1, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC.~~		\| author=
	\| journal= ~~Ann Emerg Med.~~		\| journal=
	\| year= ~~2010~~		\| year=
	\| volume= 3		\| volume=
	\| issue=55		\| issue=
	\| pages= ~~290-295~~		\| pages=
	\| pmid= ~~10.1016/j.annemergmed.2009.04.021~~		\| pmid=
	\| fulltexturl= ~~https://www.ncbi.nlm.nih.gov/pubmed/19556029~~		\| fulltexturl=
	\| pdfurl=~~http://www.annemergmed.com/article/S0196-0644(09)00482-X/pdf~~		\| pdfurl=
	}}		}}
	==Clinical Question==		==Clinical Question==
	~~Can emergency medicine physicians performing beside ultrasound measurement of the caval index predict a central venous pressure of less than 8 mmHg in emergency department patients?~~



	==Conclusion==		==Conclusion==

	~~Bedside ultrasound to measure the caval index can be a useful tool for emergency medicine physicians to predict patients with a central venous pressure of less than 8 mmHg.~~



	~~Specifically collapsibility of greater than 50% with respiration can indicate intravascular volume status.~~



	==Major Points==		==Major Points==

Panosiaa at 20:44, 5 July 2017

2017-07-05T20:44:52Z

← Revisión anterior		Revisión del 20:44 5 jul 2017
Línea 1:		Línea 1:
	{{JC info		{{JC info
	\| title=		\| title= Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure.
	\| abbreviation=		\| abbreviation=
	\| expansion=		\| expansion=
	\| published=		\| published=
	\| author=		\| author=Nagdev AD1, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC.
	\| journal=		\| journal= Ann Emerg Med.
	\| year=		\| year= 2010
	\| volume=		\| volume= 3
	\| issue=		\| issue=55
	\| pages=		\| pages= 290-295
	\| pmid=		\| pmid= 10.1016/j.annemergmed.2009.04.021
	\| fulltexturl=		\| fulltexturl= https://www.ncbi.nlm.nih.gov/pubmed/19556029
	\| pdfurl=		\| pdfurl=http://www.annemergmed.com/article/S0196-0644(09)00482-X/pdf
	}}		}}
	==Clinical Question==		==Clinical Question==
			Can emergency medicine physicians performing beside ultrasound measurement of the caval index predict a central venous pressure of less than 8 mmHg in emergency department patients?



	==Conclusion==		==Conclusion==

			Bedside ultrasound to measure the caval index can be a useful tool for emergency medicine physicians to predict patients with a central venous pressure of less than 8 mmHg.



			Specifically collapsibility of greater than 50% with respiration can indicate intravascular volume status.



	==Major Points==		==Major Points==

Panosiaa: Panosiaa moved page EBQ talk:Ultrasound Versus Computed Tomography for suspected Nephrolithiasis to Template:Journal Club Review: accidentally moved the review template and I want to put it back

2017-07-05T20:40:56Z

Panosiaa moved page EBQ talk:Ultrasound Versus Computed Tomography for suspected Nephrolithiasis to Template:Journal Club Review: accidentally moved the review template and I want to put it back

← Revisión anterior	Revisión del 20:40 5 jul 2017
(Sin diferencias)

Panosiaa at 20:40, 5 July 2017

2017-07-05T20:40:13Z

← Revisión anterior		Revisión del 20:40 5 jul 2017
Línea 1:		Línea 1:
	{{JC info		{{JC info
	\| title= ~~Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis~~		\| title=
	\| abbreviation=		\| abbreviation=
	\| expansion=		\| expansion=
	\| published=		\| published=
	\| author=~~Smith-Bindman, R., Aubin, C., Bailitz, J., Bengiamin, R.N., Camargo, C.A. Jr., Corbo, J. et al,~~		\| author=
	\| journal= ~~New England Journal of Medicine~~		\| journal=
	\| year= ~~2014~~		\| year=
	\| volume=		\| volume=
	\| issue=~~371~~		\| issue=
	\| pages= ~~1100–1110~~		\| pages=
	\| pmid= ~~10.1056/NEJMoa1404446~~		\| pmid=
	\| fulltexturl= ~~http://www.nejm.org/doi/full/10.1056/NEJMoa1404446#t=article~~		\| fulltexturl=
	\| pdfurl=~~http://www.nejm.org/doi/pdf/10.1056/NEJMoa1404446~~		\| pdfurl=
	}}		}}
	==Clinical Question==		==Clinical Question==

	~~What is the initial imaging method for patients with suspected nephrolithiasis presenting to the emergency room?~~

	==Conclusion==		==Conclusion==
	~~Ultrasound is less sensitive than CT for the diagnosis of nephrolithiasis and can be used as an initial test for patients with suspected nephrolithiasis~~

	~~Ultrasound first as the initial imaging method can result in~~		==Major Points==
	~~no CT for the most patients,~~
	~~lower cumulative radiation exposure~~
	~~no significant difference in the risk of subsequent serious adverse events~~
	~~Pain scores~~
	~~Return ED visits~~
	~~Hospitalizations~~



	~~==Major Points==~~
	Ultrasound either point-of-care or radiology was associated with a lower cumulative radiation exposure than CT without significant differences in high-risk diagnoses, serious adverse events, pain scores, return emergency department visits, hospitalizations or diagnostic accuracy in patients 18-76 years old presenting to the emergency department with suspected nephrolithiasis.

	==Study Design==		==Study Design==
	~~Multicenter, pragmatic, comparative effectiveness trial~~
	~~3638 patients were screened~~
	~~3100 eligible~~
	~~2759 patients (89% of eligible patients) underwent randomization with 908 in the point of care ultrasound, 893 to radiology ultrasound and 958 to CT scan~~

	~~No significant difference in three groups with respect to gender, age, race, self=report pain score or hospital admission after being seen in the ED~~

	~~Past medical history of kidney stones, cancer, diabetes and hypertensioin were not significantly different across the three groups.~~

	~~Of note,~~
	~~41.6% had history of kidney stones~~
	~~63.3% had hematuria~~
	~~52.5% had costovertebral- angle tenderness~~


	Physical exam findings of costoverbetral angle tenderness , right lower quadrant tenderness, left lower quadrant tenderness, murphy’s signs, McBurney’s sign, guarding as well as physicians estimated likelihood of kidney stones were obtained for the three groups with no significant difference.

	~~Patients were contacted at 3, 7, 30, 90 and 180 days to assess study outcomes~~


	==Population==		==Population==
	~~18 to 76 years old who presented to the emergency department with suspected nephrolithiasis who presented to the Emergency room in one of the 12 emergency departments~~


	===Patient Demographics===		===Patient Demographics===
	===Inclusion Criteria===		===Inclusion Criteria===
	~~18-76 years of age who reported flank or abdominal pain with ED physician who was planning to order imaging to establish or rule out primary diagnosis of kidney stones~~

	===Exclusion Criteria===		===Exclusion Criteria===
	~~Patients who the ED physician deemed were at high risk for alternative diagnoses including acute cholecystitis, appendicitis, aortic aneurysm, or bowel disorders~~
	~~Pregnant women~~
	~~Men more than 129 kg~~
	~~Women more than 113 kg~~
	~~Single kidney~~
	~~History of renal transplant~~
	~~Undergoing dialysis~~


	==Interventions==		==Interventions==
	Initial imaging based on randomization with point-of- care ultrasound examinations performed by ED physicians who had training as recommended by ACEP, radiology ultrasound performed in radiology department per guidelines and CT performed according to local standards.


	==Outcomes==		==Outcomes==
Línea 81:		Línea 38:

	===Primary Outcome===		===Primary Outcome===
	30 day incidence of high risk diagnoses (abdominal aortic aneurysm with rupture, pneumonia with sepsis, appendicitis with rupture, diverticulitisi with abscess or sepsis, bowel ischemia or perforation, renal infarction, renal stone with abscess, pyelonephritis with urospesis or bacteremia, ovarian torsion with necrosis or aortic dissection with ischemia) with complications that could be related to missed or delayed diagnosis
	~~6 month cumulative radiation exposure (calculated by amount of radiation per CT scan as well as reviewing medical records to see if patient had any repeat radiation exams)~~

	===Secondary Outcomes===		===Secondary Outcomes===
	Serious adverse events (death, life-threatening, required hospitalization, caused persistent or clinically significant diability or required medical, surgical or other intervention to prevent permanent impairment ) 16
	Related serious adverse events –three people analyzed all 466 serious adverse events and rated each on as definitely, probably, possibly related, unlikely to be related, or not related to initial randomization
	~~Pain (11 point Visual Analogue Scale)~~
	~~Return emergency department visits~~
	~~Hospitalizations~~
	~~Diagnostic accuracy (compared diagnostics to either patient’s personal observation of stone passage or surgically removed)~~



	===Subgroup analysis===		===Subgroup analysis===
	~~Ultrasound has lower sensitivity with greater specificity than CT.~~
	~~POC US (Sensitivity, Specificity) (54%, 71%)~~
	~~Radiology US (Sensitivity, Specificity) (57%, 73%)~~
	~~CT scan (Sensitivity, Specificity) (88%, 58%)~~



	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
	~~No statistical difference based on imaging method for the incidence of high risk diagnosis or related adverse events~~
	~~was low at 0.4% and did not vary based on imaging method~~
	~~The ultrasound group had statistically significantly lower mean 6 month cumulative radiation exposure compared to the CT group~~
	~~No statistical difference in serious adverse events in all three groups (12.4% of the point of care ultrasound, 10.8% in radiology ultrasound, 11.2% in CT)~~
	~~No statistical difference in the average pain score, return emergency department visits, hospitalizations and diagnostic accuracy in all three groups~~

	Patients in the ultrasonography groups were more likely that those in the CT group to have additional diagnostic testing during the emergency department visit with 40.7 % of the point of care ultrasound group and 27.0% of the radiology ultrasound group to have a CT scan performed. Only 5.1% of the CT group underwent ultrasound.

	~~Investigators, patients and physicians were not blinded to the study group assignments~~
	~~Diagnosis of stone is a very strict definition which was unbiased but some participants might foreget that they passed a stone~~
	~~Point of care ultrasound was performed by emergency physicians that have had training and certification in ultrasound and this might not be present in all emergency rooms~~


	==External Links==		==External Links==

Panosiaa: Panosiaa moved page Template:JCReview to EBQ talk:Ultrasound Versus Computed Tomography for suspected Nephrolithiasis

2017-07-05T20:30:47Z

Panosiaa moved page Template:JCReview to EBQ talk:Ultrasound Versus Computed Tomography for suspected Nephrolithiasis

← Revisión anterior	Revisión del 20:30 5 jul 2017
(Sin diferencias)

Panosiaa: Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis

2017-07-05T20:29:00Z

Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis

← Revisión anterior		Revisión del 20:29 5 jul 2017
Línea 1:		Línea 1:
	{{JC info		{{JC info
	\| title=		\| title= Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis
	\| abbreviation=		\| abbreviation=
	\| expansion=		\| expansion=
	\| published=		\| published=
	\| author=		\| author=Smith-Bindman, R., Aubin, C., Bailitz, J., Bengiamin, R.N., Camargo, C.A. Jr., Corbo, J. et al,
	\| journal=		\| journal= New England Journal of Medicine
	\| year=		\| year= 2014
	\| volume=		\| volume=
	\| issue=		\| issue=371
	\| pages=		\| pages= 1100–1110
	\| pmid=		\| pmid= 10.1056/NEJMoa1404446
	\| fulltexturl=		\| fulltexturl= http://www.nejm.org/doi/full/10.1056/NEJMoa1404446#t=article
	\| pdfurl=		\| pdfurl=http://www.nejm.org/doi/pdf/10.1056/NEJMoa1404446
	}}		}}
	==Clinical Question==		==Clinical Question==
Línea 19:		Línea 19:

	==Conclusion==		==Conclusion==
			Ultrasound is less sensitive than CT for the diagnosis of nephrolithiasis and can be used as an initial test for patients with suspected nephrolithiasis

			Ultrasound first as the initial imaging method can result in
			no CT for the most patients,
			lower cumulative radiation exposure
			no significant difference in the risk of subsequent serious adverse events
			Pain scores
			Return ED visits
			Hospitalizations



	==Major Points==		==Major Points==
			Ultrasound either point-of-care or radiology was associated with a lower cumulative radiation exposure than CT without significant differences in high-risk diagnoses, serious adverse events, pain scores, return emergency department visits, hospitalizations or diagnostic accuracy in patients 18-76 years old presenting to the emergency department with suspected nephrolithiasis.

	==Study Design==		==Study Design==
			Multicenter, pragmatic, comparative effectiveness trial
			3638 patients were screened
			3100 eligible
			2759 patients (89% of eligible patients) underwent randomization with 908 in the point of care ultrasound, 893 to radiology ultrasound and 958 to CT scan

			No significant difference in three groups with respect to gender, age, race, self=report pain score or hospital admission after being seen in the ED

			Past medical history of kidney stones, cancer, diabetes and hypertensioin were not significantly different across the three groups.

			Of note,
			41.6% had history of kidney stones
			63.3% had hematuria
			52.5% had costovertebral- angle tenderness


			Physical exam findings of costoverbetral angle tenderness , right lower quadrant tenderness, left lower quadrant tenderness, murphy’s signs, McBurney’s sign, guarding as well as physicians estimated likelihood of kidney stones were obtained for the three groups with no significant difference.

			Patients were contacted at 3, 7, 30, 90 and 180 days to assess study outcomes


	==Population==		==Population==
			18 to 76 years old who presented to the emergency department with suspected nephrolithiasis who presented to the Emergency room in one of the 12 emergency departments


	===Patient Demographics===		===Patient Demographics===
	===Inclusion Criteria===		===Inclusion Criteria===
			18-76 years of age who reported flank or abdominal pain with ED physician who was planning to order imaging to establish or rule out primary diagnosis of kidney stones

	===Exclusion Criteria===		===Exclusion Criteria===
			Patients who the ED physician deemed were at high risk for alternative diagnoses including acute cholecystitis, appendicitis, aortic aneurysm, or bowel disorders
			Pregnant women
			Men more than 129 kg
			Women more than 113 kg
			Single kidney
			History of renal transplant
			Undergoing dialysis


	==Interventions==		==Interventions==
			Initial imaging based on randomization with point-of- care ultrasound examinations performed by ED physicians who had training as recommended by ACEP, radiology ultrasound performed in radiology department per guidelines and CT performed according to local standards.


	==Outcomes==		==Outcomes==


	===Primary Outcome===		===Primary Outcome===
			30 day incidence of high risk diagnoses (abdominal aortic aneurysm with rupture, pneumonia with sepsis, appendicitis with rupture, diverticulitisi with abscess or sepsis, bowel ischemia or perforation, renal infarction, renal stone with abscess, pyelonephritis with urospesis or bacteremia, ovarian torsion with necrosis or aortic dissection with ischemia) with complications that could be related to missed or delayed diagnosis
			6 month cumulative radiation exposure (calculated by amount of radiation per CT scan as well as reviewing medical records to see if patient had any repeat radiation exams)

	===Secondary Outcomes===		===Secondary Outcomes===
			Serious adverse events (death, life-threatening, required hospitalization, caused persistent or clinically significant diability or required medical, surgical or other intervention to prevent permanent impairment ) 16
			Related serious adverse events –three people analyzed all 466 serious adverse events and rated each on as definitely, probably, possibly related, unlikely to be related, or not related to initial randomization
			Pain (11 point Visual Analogue Scale)
			Return emergency department visits
			Hospitalizations
			Diagnostic accuracy (compared diagnostics to either patient’s personal observation of stone passage or surgically removed)



	===Subgroup analysis===		===Subgroup analysis===
			Ultrasound has lower sensitivity with greater specificity than CT.
			POC US (Sensitivity, Specificity) (54%, 71%)
			Radiology US (Sensitivity, Specificity) (57%, 73%)
			CT scan (Sensitivity, Specificity) (88%, 58%)



	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
			No statistical difference based on imaging method for the incidence of high risk diagnosis or related adverse events
			was low at 0.4% and did not vary based on imaging method
			The ultrasound group had statistically significantly lower mean 6 month cumulative radiation exposure compared to the CT group
			No statistical difference in serious adverse events in all three groups (12.4% of the point of care ultrasound, 10.8% in radiology ultrasound, 11.2% in CT)
			No statistical difference in the average pain score, return emergency department visits, hospitalizations and diagnostic accuracy in all three groups

			Patients in the ultrasonography groups were more likely that those in the CT group to have additional diagnostic testing during the emergency department visit with 40.7 % of the point of care ultrasound group and 27.0% of the radiology ultrasound group to have a CT scan performed. Only 5.1% of the CT group underwent ultrasound.

			Investigators, patients and physicians were not blinded to the study group assignments
			Diagnosis of stone is a very strict definition which was unbiased but some participants might foreget that they passed a stone
			Point of care ultrasound was performed by emergency physicians that have had training and certification in ultrasound and this might not be present in all emergency rooms


	==External Links==		==External Links==

Panosiaa: /* Clinical Question */

2017-07-05T20:21:12Z

Clinical Question

← Revisión anterior		Revisión del 20:21 5 jul 2017
Línea 15:		Línea 15:
	}}		}}
	==Clinical Question==		==Clinical Question==

			What is the initial imaging method for patients with suspected nephrolithiasis presenting to the emergency room?

	==Conclusion==		==Conclusion==

Ostermayer at 17:51, 11 September 2015

2015-09-11T17:51:35Z

← Revisión anterior		Revisión del 17:51 11 sep 2015
Línea 51:		Línea 51:
	==External Links==		==External Links==

			==See Also==

	==Funding==		==Funding==


	==References==		==References==