Journal Club for 3/11

On March 11, our educator-in-chief Carl Alsup will present a meta-analysis by Al Deeb et al. on ultrasound in the ED diagnosis of acute pulmonary edema:

Point-of-care Ultrasonography for the Diagnosis of Acute Cardiogenic Pulmonary Edema in Patients Presenting Wtih Acute Dsypnea: A Systematic Review and Meta-analysis.

Academic Emergency Medicine 2014; 21:844-852.

The paper is here.

Their conclusions are that (1) moderate pretest probability plus lots of B lines is strong supporting evidence for APE, and (2) low pretest plus no B lines virtually rules out APE, with LR+ ~12, LR- ~0.06.

Probably not too surprising, since most of us regularly use ultrasound in exactly this setting. So does this review validate what we do? And how do you critically interpret a meta-analysis … isn’t the meta-analysis itself is a critical interpretation of other papers?

A brief commentary by Liu, Zehtabchi and Liteplo in the same issue summarizes why we should care and what some of the limitations are in what is usually considered a high level of evidence.

Please glance over the paper (and the commentary if you’re feeling ambitious) before Wednesday so you have lots of questions for Carl.



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