Skip to main content

Randomized, Controlled Trial of Acetaminophen, Ibuprofen, and Codeine for Acute Pain Relief in Children With Musculoskeletal Trauma.


Landmark Series
Clark E, Plint AC, Correll R, Gaboury I, Passi B. A 
Pediatrics. 20

07Mar.1;119(3):460–7.

Article Link

This high quality RCT by local investigators rigorously compared acetaminophen, ibuprofen and codeine analgesics among children in the ED with MSK trauma and found ibuprofen to be statistically and clinically significantly superior on a self-reported validated visual acuity pain scale. JC attendees felt this trial supports a change in current practice.


UPDATED Journal Club - March 2013
Methodology Score: 4.5/5              
Usefulness Score: 4.5/5

This three-armed RCT in pediatric patients presenting with MSK pain at the Children’s Hospital of Eastern Ontario found that ibuprofen provided superior analgesia (∆VAS -24mm and 52% of patients achieving adequate analgesia at 60 min) than acetaminophen (∆VAS –12mm, 36%) and codeine (∆VAS –11mm, 40%). The group agreed that this study employed a robust methodology and supported the routine use of NSAIDS in musculoskeletal pain over codeine or acetaminophen (NNT=6 vs acetaminophen), but that a multimodal approach to analgesia would provide additional benefit.
By: Dr. Andrew Willmore


Epi Lesson – Multiple Arm Clinical Trials

Multiple-arm randomized trials can be more complex in their design, data analysis, and result reporting than two-arm trials. In an RCT with three arms, there are seven theoretically possible comparisons so it is important that the investigators define a priori which comparisons are of primary interest and whether they will assess global differences between all arms and/or will assess pair-wise differences of 2 arms at a time. 
By: Ian Stiell

Comments

Popular posts from this blog

Tips for Success in your Emergency Medicine Rotation

Our wonderful medical students are preparing to start their first clinical rotations. With this in mind here are some of the top tips for success in your EM rotation
1)Be On Time – show up to your shifts on time, better yet 5 minutes early.That first impression is immensely important.
2)Introduce yourself to the team - “Hi my name is John Doe, I am the medical student on shift today” introduce yourself to the attending, residents, nurses, etc.You will be called on a lot more to help when there is something interesting going on if they know your name.
3)Be goal-oriented – have a goal for each shift, whether it’s a procedure or a type of presentation to see.
4)Don’t just stand there, do something – whenever there is a trauma or code, come to the bedside.Get gowned up for traumas and pay attention.Help with things that are within your scope of practice: chest compressions, moving patient, cardioversion
5)Don’t just stand there, do nothing – there are times in medicine when the best thing to d…

2014 Canadian Guidelines for AF Management: Part 1: Introduction and CCS “CHADS-65” Algorithm

by Ian Stiell MD @EMO_Daddy














In this and subsequent postings we will discuss the latest recommendations for ED management of atrial fibrillation (AF) as presented in the newly published 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. The Guidelines PDF can be downloaded from the CCS website at 2014 Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation
The 2014 Focused Update uses the GRADE system of evidence evaluation as was the case in the comprehensive 2010 AF Guidelines and the 2012 Update. The CCS AF Guidelines Panel is comprised of Canadian cardiologists plus physicians from internal medicine, family medicine, neurology, and emergency medicine. This 2014 Update provides evidence review and recommendations for 8 aspects of AF care, including ED Management (written by myself and Dr. Laurent Macle of the Montreal Heart Institute). The 2014 Update focuses on advances in oral anticoagulant (O…

You CAN reverse that! Reversal of NOAC's and more..

We have seen a large surge of the utilization of New Oral Anticoagulants (NOAC's) in the past few years, as such, it has been a novel challenge when these patients present to the Emergency Department (ED) with life threatening bleeding. Dr. Michael Ho looks to discuss treatment options, and future options in these patients. 
NOACs vs WarfarinDabigatran, Rivaroxaban and Apixaban have seen a dramatic increase in use since their approval in Canada. Dabigatran is a direct thrombin (Factor II) inhibitor, while the latter two are direct Xa inhibitors. These drugs are collectively referred to as novel oral anticoagulants (NOACs). They have also been called direct, or target-specific oral anticoagulants (DOACs or TSOACs) [1]. 
The NOACs have many practical advantages over warfarin: Rapid onset of actionShorter half-lifeLess food and drug interferencePredictable pharmacokineticsEase of use and no requirement for monitoringThe downsides to NOACs are the higher cost to the patient, the inabilit…