Belief has no place in science. Meta analysis of the then available data
suggested that that the probability spread went as far as 6% favourable to
steroids in brain injury. It also crossed zero so that the median was +2%.
This data supported the argument to undertake the CRASH trial which has been
described by Ian Chalmers as the best science ever undertaken in emergency
medicine.
The problem with much of the research which impinges on and has improved our
work is that it has been undertaken in other specialities. Cardiac work from
the Isis trials on affects us. Work on defibrillation, advanced life courses
of all types, management of scaphoid fractures, antibacterial use; there's a
lot out there. I think however that only work that has made a significant
difference to practice should be considered - there is quite a bit of good
work that for whatever reason is not put into standard practice.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Andrew Webster
Sent: 11 March 2007 20:33
To: [log in to unmask]
Subject: Re: Key clinical evidence in Emergency Medicine
A few suggestions........
Thrombolysis in MI and stroke
If including Canadian cervical spine rule, should also include NEXUS as
there are some arguments for using this rule instead. Jerry Hoffman...has a
conflict of interest as he was involved in the design of nexus but he has
some very persuasive arguments.
Wells criteria for risk stratifying thromboembolic disease
Is the CRASH trial a Key clinical trial, as many people believed steroids
were never going to be effective in the first place?
Andy Webster
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Robin Illingworth
Sent: 11 March 2007 20:22
To: [log in to unmask]
Subject: Key clinical evidence in Emergency Medicine
I would be grateful for help in identifying the most important clinical
evidence in Emergency Medicine.
I have been asked to help with the Emergency Medicine section of a new
Oxford Handbook, the "Oxford Handbook of Key Clinical Evidence". This will
cover all the medical and surgical specialties, with summaries of the
"landmark clinical trials" which currently influence clinical practice.
These should, if possible, be level 1 evidence, i.e. RCTs, randomised
controlled trials published in peer-reviewed journals.
Not much of the clinical work in Emergency Medicine is based on level 1
evidence, but there is some.
Some clinical decision rules, such as the Canadian C-spine rule and the
Ottawa ankle and knee rules, are based on cohort studies rather than RCTs,
but I think they should be included as "key clinical evidence".
One RCT which should be included is the MRC CRASH trial of corticosteroids
in head injury (Lancet 2004; 364: 1321-8). Another is the Nasal Diamorphine
Trial (BMJ 2001; 322: 261-5).
Clinical management of acute coronary syndromes is based on many RCTs which
are relevant to Cardiology as well as Emergency Medicine. There will be
discussions with cardiologists to choose the most important trials. I am
looking through various SIGN guidelines and Cochrane reviews.
I would be grateful for ideas and suggestions about the "key clinical
evidence" which influences current practice in Emergency Medicine.
Robin
Dr Robin Illingworth
Consultant in Emergency Medicine
St James's University Hospital, Leeds.
--
Robin Illingworth, Leeds ([log in to unmask])
-------------------------------------------
|