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Glasgow Coma Scale in Children

Pediatric EM Morsels

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. A practical scale. PMID: 4136544.

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The Power Of Trauma Research?

The Trauma Pro

A group of investigators from Jackson Memorial in Miami and Denver Health published a paper earlier this month that critically reviewed 187 trauma surgery RCTs published from 2000 to 2021. Among 30 studies that had a statistically significant binary outcome, the mean fragility index was 2.

Research 113
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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.

Stroke 91
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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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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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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.

Stroke 113
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REBEL Cast Ep116: The CLOVERS Trial – Restrictive vs Liberal Fluids in Sepsis-Induced Hypotension

RebelEM

The secondary outcome of mortality was not statistically different however numerically favored the early use of norepinephrine. It is unclear if outcomes would have differed with different targets or allowing for lower blood pressure values Trial protocol was only for 24 hours after randomization. Liberal: 14.9% Liberal: 14.9%

Sepsis 105