Journal Club is a recurring event where Emergency Medicine Faculty and Residents review and critically appraise key publications of importance to the practice of Emergency Medicine in Canada.

CCFP-EM and FRCPC residents, with assistance from Department Research Staff, critically appraise selected articles as per standard format and present their analyses to the group.

Critical appraisal tools can be found on the Critical Appraisal Skills Programme website:

2018/2019 Journal Club Schedule

Sep 5, 2018


  1. Frank Peacock, MD et al, “Efficacy of High-Sensitivity Troponin T in Identifying Very-Low-Risk Patients With Possible Acute Coronary Syndrome,” JAMA Cardiol. 2018;3(2):104-112. doi:10.1001/jamacardio.2017.4625
  2. Ross EM et al, “Dual defibrillation in out-of-hospital cardiac arrest: A retrospective cohort analysis” Resuscitation. 106 (2016): 14-17.

Oct 3, 2018


  1. Unneby et al, “Femoral nerve block in a representative sample of elderly people with hip fracture: A randomised controlled trial” Injury, Int. J. Care Injured 48 (2017) 1542–1549.
  2. Daoust R et al, “Recent opioid use and fall-related injury among older patients with trauma” CMAJ 2018 April 23;190:E500-6. doi: 10.1503/cmaj.171286

Nov 7, 2018


  1. Albers GW et al, “DEFUSE: Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging,” NEJM
  2. Grool AM et al, “Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents,” JAMA. 2016;316(23):2504-2514. doi:10.1001/jama.2016.17396

Dec 5, 2018


  1. Ratwani R et al, “Emergency Physician Use of Cognitive Strategies to Manage Interruptions,” Annals of Emergency Medicine Vol 70(5):683.
  2. Syed S et al, “Prospective validation of a clinical decision rule to identify patients presenting to the emergency department with chest pain who can safely be removed from cardiac monitoring,” CMAJ 2017 January 30;189:E139-45. doi: 10.1503/cmaj.160742

 Jan 9, 2018


  1. Osmond M et al, “Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department,” CMAJ 2018 July 9;190:E816-22. doi: 10.1503/cmaj.170406.
  2. Luck R et al (2013), “Comparison of Cosmetic Outcomes of Absorbable Versus Nonabsorbable Sutures in Pediatric Facial Lacerations,” Pediatric Emergency Care 29: 691-695.

Feb 6, 2018


  1. Siegal DM et al (2015), “Andexanet Alfa for the reversal of Factor Xa inhibitor activity,” NEJM 373(25): 2413-24.
  2. Zahed R et al, “Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial,” Academic Emergency Medicine (2018) Vol 25(3).

Mar 6, 2018


  1. Oqab Z et al (2018), “Prevalence of pulmonary embolism in patients presenting with syncope. A systematic review and meta-analysis,” American Journal of Emergency Medicine 36: 551-555.
  2. Wan T et al (2017), “Guidance for the diagnosis of pulmonary embolism during pregnancy: Consensus and controversies,” Thrombosis Research, 157: 23-28.

Apr 3, 2018


  1. Self W et al. “Balanced Crystalloids versus Saline in Noncritically Ill Adults,” N Engl J Med 2018;378:819-28.DOI: 10.1056/NEJMoa1711586
  2. Moran GJ et al, “Effect of Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis A Randomized Clinical Trial,” JAMA May 23/30, 2017 Volume 317, Number 20.

 May 1, 2018


  1. Perelman VS et al (2004), “Sterile versus nonsterile gloves for repair of uncomplicated lacerations in the emergency department: a randomized controlled trial”. Annals of Emergency Medicine. 43(3):362-70, 2004 Mar.
  2. Fernandez R, Griffiths R (2012), “Water for wound cleansing,” Cochrane Database of Systematic Reviews 2, CD003861.

Past Journal Club Articles:


General Surgery

  • Talan D et al (2017), “Antibiotics-First Versus Surgery for Appendicitis: A US Pilot Randomized Controlled Trial Allowing Outpatient Antibiotic Management,” Annals of Emergency Medicine 70(1).
  • Salminen P et al (2015), “Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis
The APPAC Randomized Clinical Trial,” JAMA 313(23):2340-2348.


  • Stiell I et alI (2001), “The Canadian CT Head Rule for patients with minor head injury,” The Lancet 357 (9266): 1391-1396.
  • Easter J et al (2013), “Traumatic Intracranial Injury in Intoxicated Patients With Minor Head Trauma,” Academic Emergency Medicine 20:754-760.


  • Bas M et al (2015), “A Randomized Trial of Icatibant in ACE-Inhibitor–Induced Angioedema,” New England Journal of Medicine, 372(5):418-425.
  • Grunau BE et al (2015), “Emergency Department Corticosteroid Use for Allergy or Anaphylaxis Is Not Associated With Decreased Relapses,” Annals of Emergency Medicine 66(4):381-389.

Infectious Diseases

  • Hayward GN et al (2017), “Effect of Oral Dexamethasone Without Immediate Antibiotics vs. Placebo on Acute Sore Throats in Adults: A Randomized Clinical Trial,” JAMA, 317(15):1535-1543.
  • Marik P et al (2017), “Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock
A Retrospective Before-After Study,” Chest,  151(6):1229-1238.


  • Newman-Toker DE et al (2013), “HINTS Outperforms ABCD2 to Screen for Stroke in Acute Continuous Vertigo and Dizziness,” Academic Emergency Medicine, 20:987-996.
  • Perry JJ et al (2013), “Clinical decision rules to rule out subarachnoid hemorrhage for acute headache,” JAMA, 310(12):1248-55.


  • Thiruganasambandamoorthy V et al  (2016), “Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope,” CMAJ, 188(12).
  • Appelboam A et al (2015), “Postural modification of the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial,” Lancet, 386(10005): 1747-53.

(ED-Focused) Health Policy

  • Fraser J et al (2017), “A comparative study of patient characteristics, opinions, and outcomes, for patients who leave the emergency department before medical assessment,” CJEM, 19(5):347-354.
  • Spin P et al (2017), “A Cost Analysis of Salbutamol Administration
by Metered-Dose Inhalers with Spacers versus Nebulization for Patients with Wheeze in the Pediatric Emergency Department: Evidence from Observational Data in Nova Scotia,” CJEM, 19(1):1-8.



  • Kudenchuck PJ, et al. Amiodarone, lidocaine, or placebo in out-of-hospital cardiac arrest. N Engl J Med 2016;374:1711-22
  • Lee YH, et al. Refractory ventricular fibrillation treated with esmolol. Resuscitation 2016;107:150-5


  • Weekes AJ, et al. Diagnostic accuracy of right ventricular dysfunction markers in normotensive emergency department patients with acute pulmonary embolism. Ann Emerg Med 2016;68(3):277-91
  • Gaspari R, et al. Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest. Resuscitation 2016;109:33-39

Respirology & Ventilation

  • Reher MW, et al. A randomized controlled noninferiority trial of single dose of oral dexamethasone versus five days of oral prednisone in acute adult asthma. Ann Emerg Med 2016;68(5):608-13
  • Girardis R, et al. Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit: the oxygen-ICU randomized clinical trial. JAMA 2016;316(15):1584-9



  • Ferrer R, Martin-Loeches I, Phillips G, et al. Emipiric antibiotic treatment reduces mortality in severe septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med 2014;42(8):1749-55.
  • Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med 2015;372:1301-11


  • Holcomb JB, et. al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA 2015; 313(5):471-82
  • Cooper DJ, et. al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011; 364(16):1493-1502

Pre-Hospital Medicine

  • Sanghavi P, Jena AB, Newhouse JP, Zaslavsky AM. Outcome of basic versus advanced life support for out-of-hospital medical emergencies. Ann Intern Med 2015; 163(9):681-90
  • Nichol G, et. al. Trial of continuous or interrupted chest compressions during CPR. N Engl J Med 2015; 373(23)2203-14

​Lipid Emulsion Therapy

  • Varney SM, Bebarta VS, Boudreau SM, Bargas TE, Castaneda M, Zarzabal LA. Intravenous lipid emulsion therapy for severe dihenhydramine toxicity: A randomized, controlled pilot study in a swine model. Ann Emerg Med 2016; 67(2):196-205
  • Heinonen JA, Litnius E, Salmi T, Haasio J, Tarkkila P, Backma JT, Rosenberg PH. Intravenous lipid emulsion given to volunteers does not affect sympoms of lidocaine brain toxicity. Basic Clin Pharmacol 2015; 116:378-83

Mental Practice & Cognitive Bias in EM

  • Lorello GR, Hicks CM, Ahmed SA, Unger Z, Chandra D, Hayter MA. Mental practice: A simple tool to improve team based trauma resuscitation. CJEM 2016; 18(2):136-42
  • Croskerry P. From mindless to mindful practice: Cognitive bias and clinical decision making. N Engl J Med 2013; 368(26):2445-9
  • Moore CL, Bomann S, Daniels B, et al. Derivation and validation of a clinical prediction rule for uncomplicated ureteral stone–the STONE score: retrospective and prospective observational cohort studies. BMJ;348:g2191.
  • Smith-Bindman R, Aubin C, Bailitz J, et al. Ultrasonography versus computed tomography for suspected nephrolithiasis. N Engl J Med;371:1100-10.
Pre-Hospital Airway
  • Hasegawa K, Hiraide A, Chang Y, Brown DF. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA;309:257-66.
  • Stiell IG, Wells GA, Field B, et al. Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med 2004;351:647-56.
Post-Arrest Hypothermia
  • Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002;346:549-56.
  • Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. N Engl J Med;369:2197-206.
  • Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77.
  • Yealy DM, Kellum JA, Huang DT, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med;370:1683-93.


  • Ezekowitz et al.  Rationale and design of RE-LY: Randomized evaluation of long-term anticoagulant therapy, warfarin, compared with dabigatran.  American Heart Journal 157:805-510, 2009.
  • Connolly et al.  Dabigatran versus Warfarin in Patients with Atrial Fibrillation.  NEJM 361(12): 1139-51, 2009.
  • Shulman et al.  Dabigatran versus Warfarin in the Treatment of Acute Venous Thromboembolism.  NEJM 361(24): 2342-52, 2009.
  • Engstrom et al.  Prednisolone and Valaciclovir in Bell’s Palsy:  a randomized, double blind, placebo controlled multicentre trial.  Lancet Neurology, 2008;7: 993-1000.
    Sullivan et al.  Early treatment with prednisolone or acyclovir in Bell’s Palsy. NEJM 357; 16: 1598-1607.
  • Corneli et al.  A multicenter randomized controlled trial of dexamethasone for bronchioitis.  NEJM 357; 4: 332-9, July 26, 2007.
    Plint et al.  Epinephrine and dexamethasone in children with bronchiolitis.  NEJM 360; 20: 2079-89, May 14, 2009.


  • COMMIT Group. Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction. Lancet 366: 1688. Nov. 2005.
  • Sabatine et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST segment elevation. NEJM 352(12):1179. March 15, 2005.
  • Stiell et al The OPALS Major Trauma Study. CMAJ 2008; 178(9):1141-52Cooper et al.
  • Prehospital Hypertonic Saline Resuscitation of Patients with Hypotension and Severe Traumatic Brain Injury. JAMA March 17, 2004; 291(11):1350-57.
  • Morley et al.  “Part 3:  Evidence Evaluation Process; 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations”. Circulation. Volume 122 Issue 16 Supplement 2, October 18, 2010.
  • Morrison et al.  “Part 8:  Advanced Life Support; 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations”. Circulation. Volume 122 Issue 16 Supplement 2, October 18, 2010.
  • HACA Study Group.  Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest. NEJM 346:8, 549-56; Feb 21 2002.
  • Bernard et al. Treatment of Comatose Survivors of Out of Hospital Cardiac Arrest with Induced Hypothermia.  NEJM 346:8, 557-563; Feb 21 2002.Verbeek PR et al.  Derivation of a termination-of-resuscitation guideline for emergency medical technicians using automated external defibrillators. Academic Emergency Medicine.  9(7):671-8, 2002 Jul.
  • Morrison et al.  Validation of a Rule for Termination of Resuscitation in Out of Hospital Cardiac Arrest.  NEJM 355:5  Aug. 2006
  • Morrison et al.  Validation of a universal prehospital termination of resuscitation clinical prediction rule for advanced and basic life support providers. Resuscitation.  80(3):324-8, 2009 Mar.Decker et al.  A Prospective Randomized Trial of an Emergency Department Observation Unit for Acute Onset Atrial Fibrillation.  Annals of Emergency Medicine 52(4):322; October 2008.
  • Stiell et al.  Association of the Ottawa Aggressive Protocol with Rapid Discharge of Emergency Department Patients with Recent-Onset Atrial Fibrillation or Flutter.  CJEM 12(3): 181; May 2010.


  • Reichlin T et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 2009;361:858-67.
  • Keller T et al. Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 2009;361:868-77.
  • Singh J et al. Incidence and predictors of critical events during urgent air medical transport. CMAJ 2009;181:580-4.
  • Garza A et al. Improved patient survival using a modified resuscitation protocol for out-of-hospital cardiac arrest.  Circulation 2009;119:2597-2605.
  • Bjornson C et al. A randomized trial of a single dose of oral dexamethasone for mild croup. N Engl J Med 2004;351:1306-13.
  • Corneli H et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis.N Engl J Med 2007;357:331­9.
  • Panickar J et al. Oral prednisolone for preschool children with acute virus-induced wheezing. N Engl J Med 2009;360:329-38.
  • Plint A et al. Epinephrine and bronchiolitis in children with bronchiolitis. N Engl J Med 2009;360:329-38.
  • Colman I et al. Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ 2008;336:1359-1361.
  • Kely AM et al. The relative efficacy of phenothiazines for the treatment of acute migraine: a meta-analysis. Headache 2009;49:1324-1332.