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Does the implementation of a trauma system affect injury-related morbidity and economic outcomes? A systematic review

Emergency Medicine Journal

Methods We performed a systematic review to explore the impact the implementation of a trauma system has on morbidity, quality of life and economic outcomes, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

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Impact of trauma systems on injury morbidity: important considerations for low-income and middle-income countries

Emergency Medicine Journal

1 In their EMJ paper, Bath et al report the results of a systematic review of comparator study types published since 2000 that investigated the impact of organised trauma systems on morbidity, quality of life and economic outcomes. Lastly, two studies evaluated health economic and cost-effectiveness outcomes. One demonstrated.

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A Simple Study May Herald a Big Change in Evidence-Based Medicine

Sensible Medicine

Did the new treatment reduce the bad outcome so much so that the difference meets a statistical threshold? Two examples explain the challenge of using statistics to judge science In large studies, a tiny difference in outcomes—one that is not “clinically” significant can easily reach statististical significance.

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Choosing a Control Group

Sensible Medicine

This has the effect of balancing known and unknown factors, which could affect the primary outcome. The primary outcome of interest was excess burden of multiorgan abnormalities (two or more organs) relative to controls. It was covered by 194 news outlets and tweeted by nearly 2000 accounts, including some very high profile doctors.

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Part 2 - The ELAN Trial Forces Doctors to Be Mature About Using Medical Evidence

Sensible Medicine

The primary outcome was a composite of lots of bad things—stroke, systemic embolism, intracranial bleeding, extracranial bleeding, and death due to cardiovascular causes. The Results A primary outcome occurred in 2.9% indicates a 30% reduction of bad outcomes with early anticoagulation. in the later treatment arm.

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Ortho Pearls: Metacarpal Fracture Management

Cook County EM Blog

If there are no indications for surgery, the patient can be immobilized in a cast for four weeks with good outcomes. 2000 Sep;25(5):817-23. Metacarpal fractures: treatment and complications. Hand (N Y). 2014;9(1):16-23. doi:10.1007/s11552-013-9562-1 Stern PJ. Management of fractures of the hand over the last 25 years. J Hand Surg Am.

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Small Trials vs Large Trials

Sensible Medicine

ISIS-4, with it’s nearly 60,000 patients and more than 2000 events in each treatment group, definitively shows that IV-Mg had no effect on mortality. Now, we randomize fewer patients but record composite outcomes, which may include things like, death and MI and stroke and coronary revascularization. LIMIT-2 publishes in 1992.

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