Maybe I am being pedantic (gasps of shock - quite out of
character!), but this study would not answer the question. This is
research not audit. The question appears to be "Is it better to fix
fractures early?". A data collection exercise and multivariate
analysis would involve a huge amount of effort, but not answer this
question. If the results were positive (more FES the longer fixation
was delayed) what would the conclusion be? Maybe late fixation
causes FES. BUT, maybe another factor (such as multiple injury)
causes both late fixation and FES.
A large data collection exercise would entail a huge amount of work,
and would not add to the sum of knowledge about this area.
If this is really a crucial gap in the knowledge of emergency
medicine we should push it as a topic to be included in the
Faculty's suggestion to the Health Technology Assessment
Program for NHS R&D Commissioning. (Or submit it ourselves to
their website). This way the appropriate method (a randomised trial)
might be funded.
Tim.
> It would appear from the papers quoted that there is a better outcome
> from early repair. So one could set a relative standard of repair
> using a multivariate analysis to see if there is a cut off point (12
> hours, 24 hours, 36 hours, whatever) beyond which the risk of
> symptomatic FSE becomes too great to be acceptable.
>
Timothy J Coats MD FRCS FFAEM
Senior Lecturer in Accident and Emergency / Pre-Hospital Care
Royal London Hospital, UK.
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|