CanadiEM Journal Club E04 Systematic reviews and meta analyses show notes Welcome back to Journal Club by CanadiEM! In this episode we go over an approach to systematic reviews and meta analyses based on Oxford centre of EBM, and learn about diagnosing pneumothorax with ultrasound vs X-ray Using the Oxford centre of EBM tool, we will ask: What question(s) did the systematic review address? Is it likely that important, relevant studies were missed? Were the criteria used to select articles for inclusion appropriate? Were the included studies sufficiently valid for the type of question asked? Were the results similar from study to study? What were the results? What is the clinical significance of the results? and then a clinical pearl on pneumothorax!! Hosts:  Dakoda Herman Jayneel Limbachia Jake Domm Paper: “Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department” Cochrane Database of Systematic Reviews by Chan KK, Joo DA, McRae AD, Takwoingi Y, Premji ZA, Lang E, Wakai A   What question(s) did the systematic review address? P: Trauma patients in the ER I: chest ultrasonography by non rad physicians C: Chest xray O: diagnosis of pneumothorax, improved patient safety  Secondary: investigate potential sources of hetero such as type of CUS operator, type of trauma, type of US probe on test accuracy T: inception to 10 April 2020   Is it unlikely that important, relevant studies were missed? This study included prospective, paired comparative  accuracy studies in which patients were suspected of having pneumothorax. Patients must have undergone both CUS by a frontline non-radiologist and CXR, as well as CT of the chest or tube thoracostomy as the reference standard. The authors carried out systematic searches in the following electronic databases: Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; MEDLINE; Embase; Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus; Database of Abstracts of Reviews of EIects; Web of Science core collection (which includes: Science Citation Index Expanded; Social Sciences Citation Index; Arts & Humanities Citation Index; Conference Proceedings Citation Index - Science; Conference Proceedings Citation Index - Social Sciences & Humanities; and Emerging Sources Citation Index; and Clinicaltrials.gov from database creation to April 2020. The authors also handsearched reference lists of included articles and reviews, retrieved via electronic searching, for potentially eligible studies. Additionally, they carried out forward citation searching of relevant articles in Google Scholar and looked at the “Related articles” on PubMed. They did not limit the search to Englsih language only and included articles published in all languages. Their search strategy in volved the use of MeSH terms such as Pneumothorax, Radiography, Ultrasonography, and focused assessment with ultrasonography for trauma. They also used many text words. Using this search strategy 3473 records were identified. 1180 duplicated records were removed, leaving 2293 records to be screened. These records were screened by two of the authors for their relevance, when there was a discrepancy a third author decided whether to include the record or not. 2268 records were excluded, leaving 25 full-text articles that were assessed for eligibility. 12 studies were excluded - 5 missing CUS/CXR/CT chest/chest tube, 4 CUS not performed by frontline non-radiologist physicians, 2 wrong patient population, 1 wrong study design. A total of 13 studies were included in qualitative and quantitative analysis. 9 studies using patients as units of analysis included in primary analysis. 4 studies using lung fields as units of analysis included in secondary analysis. Authors provide a nice figure depict