BMC Emergency Medicine Journal Club

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BMC Emergency MedicineJournal Club

• Smokin hot musculoskeletal research from SAEM
  2009
• May 2009

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Todays Agenda

• Musculoskeletal Disorders
• Wrenn Levenberg (EM2)
• Andrea Stanton (EM1)

BMC EM Journal Club
BMC EM Journal Club
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Upcoming Final Journal Club

• June 9 Nervous System Disorders
• Alison Sullivan (EM1)
• Thomas Horesji (EM1)
• June 9 Senior Resident Scholars Forum

BMC EM Journal Club
BMC EM Journal Club
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SAEM Abstracts
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SAEM Abstracts Scoring
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BMC Emergency MedicineJournal Club

• Smokin hot musculoskeletal research from SAEM
  2009
• Andrea Stanton, MD

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Abstract 74

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Abstract 74

• Objective Compare hot and cold packs in
  relieving pain from back and neck strains.
• Methods
• Randomized control trial
• Ibuprofen 400mg
• Randomized to 30 minutes hot or cold pack
• 100-mm VAS pain scale

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Abstract 74

• Key Results
• No difference between hot and cold packs
• Conclusion
• Hot and cold packs resulted in similar pain
  relief in back and neck strains

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Abstract 74 Score

• Objectives 2/2-clearly stated
• Methodology 6/6
• Results 4/4
• Conclusions 2/2
• Originality 1/2
• Impact 2/4-small change in practice
• Total 17/20

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Abstract 74 Final Thoughts

• Overall I thought this was a good abstract with a
  clear objective and a good study design.
• Strengths-RCT, common problem
• Weakness-control group, chronic pain

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Abstract 236
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Abstract 236

• Objective determine the association between
  weight and UEF in children
• Methods
• Secondary analysis of data
• Ages 5-14y with UEF, sprain or fever
• Weight for age/gender gt50th percentile
• Logistic regression to generate odds ratios

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Abstract 236

• Key Results
• Odds of having an elevated weight increased in
  5-9y with UEF (OR 3.4, 4.9)
• Odds of having an elevated weight are decreased
  among UEF age 10-14y
• Conclusion
• Elevated weight is associated with UEF in
  pre-pubescents, and has a negative association in
  pubescents.

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Abstract 236 Score

• Objectives 1/2-difficult to test
• Methodology 4/6-secondary analysis
• Results 2/4-not clearly present
• Conclusions 2/2
• Originality 1/2
• Impact 1/4
• Total 11/20

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Abstract 236 Final Thoughts

• Overall, I did not like this abstract. I thought
  it was difficult to read and not very relevant to
  my practice.
• Strengths-controls
• Weakness-secondary analysis of data, difficult to
  read, unclear relevance

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Abstract 463
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Abstract 463

• Objective assess current utilization of
  selective spine immobilization in the USA
• Methods
• Standardized survey instrument to 50 US EMS
  Directors
• Descriptive statistics

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Abstract 463

• Key Results
• 100 response, 23 states utilize a protocol with
  varying levels of implementation. 14 states
  indicated the practice is under consideration
• Conclusion
• Selective spine immobilization for EMS is
  currently in use in many states with additional
  states considering implementation.

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Abstract 463 Score

• Objectives 2/2
• Methodology 3/6-unclear survey
• Results 2/4
• Conclusions 2/2
• Originality 1/2
• Impact 1/4
• Total 11/20

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Abstract 463 Final Thoughts

• Overall, I thought this was an interesting
  abstract that piqued my interest but left many
  questions unanswered.
• Strengths-100 responses, straightforward design
  and statistics, interesting question
• Weakness-unclear survey, protocols

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BMC Emergency MedicineJournal Club

• Smokin hot musculoskeletal research from SAEM
  2009
• Wrenn Levenberg, MD

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Abstract 473 Background

• 2 piece vs. 1 piece
• Multiple brands
• Adjustable vs. not
• Application challenges

www.emsvillage.com EMERGENCY CARE ESSENTIALS
FORUM
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Abstract 473

• Objective
• Assess quality of c-collar application by EMS
• Methods
• Cross-sectional, observational
• Noncritically ill, immobilized patients
• Standardized manufacturer specifications
• EMS providers surveyed

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Abstract 473

• N 171
• 28 correctly applied
• 64 of incorrectly applied had gt2 errors
• Provider training made no difference
• Suspicion of injury (p0.5) or severity of injury
  (p0.25) made no difference

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Abstract 473

• Conclusions
• Most patients are transported to ED with
  improperly applied c-collars, regardless of level
  of provider training or concern for injury

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Abstract 473 Score

• Objectives 2
• Methodology 3
• Results 4
• Conclusions 1
• Originality 1
• Impact 2
• Total 13/20

BMC EM Journal Club
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Abstract 473 Final Thoughts
Highly relevant Early assessment needed
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Abstract 178

• Objectives
• Validate a screening tool for pelvic fracture
• Deduce sensitivity of standard AP pelvic x-ray
• Methods
• Prospective, observational, adults
• X-ray and CT performed
• 4 high risk features
• SBP lt 90 mmHg, GCS lt 14, pelvis instability,
  tenderness
• Descriptive Statistics

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Abstract 178

• N4028
• 254 / 4028 (6) fracture
• 227 / 254 (89) at least 1 high risk feature
• 204 / 254 (80) fracture seen on AP film
• 12 / 27 (44) fractures without high risk
  features seen on AP film

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Abstract 178

• Conclusions
• Screening tool identifies most fracture pts
• For patients without high risk features, AP
  identified fractures only half of the time

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Abstract 178 Score

• Objectives 2
• Methodology 6
• Results 4
• Conclusions 1
• Originality 1
• Impact 3
• Total 17/20

BMC EM Journal Club
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Abstract 178 Final Thoughts
Screening Tool -GCS lt 14 -SBP lt 90 -Pelvis
instability -Pelvis tenderness
-What types of fractures were missed?
-Consequences?
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Abstract 514

• Objective
• Does ED crowding delay back pain analgesia?
• Methods
• Retrospective, 2 urban EDs 2000-07
• 1outcome receipt of any ED analgesia
• 2outcomes
• gt 1h delay in getting analgesia
• Measures of ED crowding
• waiting room, ED, patient-hours,
  admitted

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Abstract 514

• N8452
• 6027 (71) received any analgesia
• Adjusted for Demographics, triage class, pain
  severity
• At most crowded times
• RR of going untreated 0.70
• RR of delay in treatment 1.4

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Abstract 514

• Conclusions
• ED crowding is associated with a higher
  likelihood of receiving pain medication in
  patients with back pain.
• But, those who are treated experience longer
  waits.

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Abstract 514 Score

• Objectives 2
• Methodology 5
• Results 3
• Conclusions 2
• Originality 1
• Impact 2
• Total 15/20

BMC EM Journal Club
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Abstract 514 Final Thoughts

• Good sample size, too much data
• Data not surprising
• Retrospective-some study outcomes cant be
  explained
• Can reassure patients they will be treated,
  eventually

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Upcoming Final Journal Club

• June 9 Nervous System Disorders
• Alison Sullivan (EM1)
• Thomas Horesji (EM1)
• June 9 Senior Resident Scholars Forum

BMC EM Journal Club
BMC EM Journal Club
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(No Transcript)