Cohort

David J-S et al.
Does the prognosis of cardiac arrest differ in trauma patients?
Crit Care Med
2007;35:2251-2255.

Submitted by:John Butler - A&E Consultant
Institution:MAnchester Royal Infirmary
Date submitted:1st November 2007

Before CA, i rated this paper: 6/10

1 Objectives and hypotheses

2 Design

2.4 Were outcomes defined at the start of the study?

Outcomes were defined. Study was cohort analysis of European Epinephrine Study Group's trial.

2.5 Was this the right sample to answer the objectives?

Small numbers of trauma cases 268 in a condition with such a poor outcome anyway to determine difference in mortality outcome.

2.6 Is the study large enough to achieve its objectives? Have sample size estimates been performed?

NO.

2.7 Were all subjects accounted for?

Yes. Figure 1.

2.8 Were all appropriate outcomes considered?

Probably. Number of successful organ donors ?? possibly

2.9 Has ethical approval been obtained if appropriate?

Yes for main study.

3 Measurement and observation

3.1 Is it clear what was measured, how it was measured and what the outcomes were?

Yes.

3.2 Was the assessment of outcomes blinded?

Yes

3.3 Was follow up sufficiently long and complete?

Follow up for one year with neurological outcomes recorded. Yes

3.4 Are the measurements valid?

Yes

3.5 Are the measurements reliable?

Yes

3.6 Are the measurements reproducible?

Yes

4 Presentation of results

4.1 Are the basic data adequately described?

Table 1. Details of traumatic injuries not given by paper. Severity of injuries not given.

4.2 Are the results presented clearly, objectively and in sufficient detail to enable readers to make their own judgement?

Yes

4.3 How large are the effects within a specified time?

4.4 Are the results internally consistent, i.e. do the numbers add up properly?

Yes.

5 Analysis

5.1 Are the data suitable for analysis?

Yes

5.2 Are the methods appropriate to the data?

Yes. Variety of statistical tests are used.

5.3 Are any statistics correctly performed and interpreted?

Unknown.

6 Discussion

6.1 Are the results discussed in relation to existing knowledge on the subject and study objectives?

Yes.

6.2 Is the discussion biased?

Possibly. The authors suggest that paper shows that traumatic OHCA victims should be resuscitated. Perhaps another way to look at this would be that neither group should be resuscitated unless situation is very favourable ie. Good CPR, shockable rhythm, short downtime etc.

7 Interpretation

7.1 Are the author's conclusions justified by the data?

To some extent. Data could be interpreted differently by other readers.

7.2 What level of evidence has this paper presented? (using CEBM levels)

7.3 Does this paper help me to answer my problem?

Yes.

After CA, i rated this paper: 5/10

8 Implementation

8.1 Can any necessary change be implemented in practice?

Yes

8.2 What aids to implementation exist?

8.3 What barriers to implementation exist?

8.4 Are the study patients similar to your own?

Patients are similar. Medical system is different.

8.5 Does the paper give any conclusions that will affect what you will offer or tell your patient?

Futility of resuscitation may be one conclusion drawn.