Skip to main content

Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial

Landmark Series
Methodology Score: 4/5                 
Usefulness Score: 4/5

CRASH-2 trial collaborators
Lancet. 2010 Jul 3;376(9734):23-32.


This large RCT assessed the effect of early administration of tranexamic acid to trauma patients and revealed statistically significant results in favour of TXA for the reduction of overall death and death from bleeding without significant adverse effects (0.91 (95% CI 0.85–0.97, p=0·0035); NNT 67).
The group felt this was methodologically sound and practice changing trial however questions were raised as to some aspects of the selection criteria ("physicians uncertainty"). By: Dr. Pamela Kapend
(Presented Feb 2014)


Epi lesson: Number Needed to Treat (NNT)

NNT is an epidemiological measure used in assessing the effectiveness of a health-care intervention. The NNT is the average number of patients who need to be treated to prevent one additional bad outcome compared with a control in a clinical trial. It is defined as the inverse of the absolute risk reduction. The ideal NNT is 1, where everyone improves with treatment and no one improves with control. The higher the NNT, the less effective is the treatment. While NNTs are easy to interpret, making them popular with consumers and clinicians, they cannot be used for performing a meta-analysis because of their mathematical properties. 
By: Dr. 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…

The Canadian Syncope Risk Score

Guest post by Dr. Venkatesh Thiruganasambandamoorthy.
Syncope is an commonly encountered problem in Emergency Medicine, with the potential for significant morbidity and mortality to patients. Unfortunately, to date, there have not been any reliable decision tools or instruments to help us in our assessment of the syncope patient.  This week, Venkatesh Thiruganasambandamoorthy and colleagues at the Ottawa Hospital have published an new Canadian Syncope Risk Score to identify patients at risk of serious adverse events, published in CMAJ.1 Here, Dr. Venk helps provides some further insight and potential utilization of the risk score, he may also be heard discussing this rule on the March edition of Canadian EMRAP.


BackgroundSyncope constitutes 1% of Emergency Department (ED) visits, and approximately 10% of these patients will have serious underlying conditions causing syncope (arrhythmia, MI, serious structural heart disease, pulmonary embolism, subarachnoid or severe hemorrhage). Alarmin…

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…