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

Sensible Medicine

Early vs late initiation of oral anticoagulation after an ischemic stroke due to atrial fibrillation. 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%

Stroke 84
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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.

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

RebelEM

These patients can have a vasodilated vascular bed and the initial use of fluids is hypothesized to serve two purposes: Augmenting the macrovascular system (stroke volume and cardiac output) and augmenting the microvascular perfusion (capillary blood flow). This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Liberal: 14.9%

Sepsis 105
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Doing statistics can be difficult but understanding them can be fairly simple

Sensible Medicine

In the assessment of a clinical trial, we want to know if differences in baseline characteristics may have played a role in the observed outcome. The question to consider is…are the actual differences seen between the groups with regards to baseline characteristics large enough to have influenced the outcome?

Outcomes 108
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Issue #2: The Latest in Critical Care, 5/22/23

PulmCCM

Early mobilizers got significantly more exercise, but had no improvement in any clinical outcome (days alive outside the hospital, ventilator-free days, ICU-free days, or cognitive or psychological function). In an NHLBI-sponsored trial enrolling 1563 patients at 60 U.S.