Cohort

elliot r haut, brian kalish, bryan cotton, david efron, adil haider, kent a. stevens, alicia kieninger, edward cornwell, david c chang
Prehospital Intravenous Fluid Administration is Associated With Higher Mortality in Trauma Patients: A National Trauma Data Bank Analysis
Annals of Surgery
2011,

Submitted by:James Smith - Medical Student
Institution:Indiana University School of Medicine
Date submitted:22nd June 2011

Before CA, i rated this paper: 8/10

1 Objectives and hypotheses

1.1 Are the objectives of the study clearly stated?

Yes

2 Design

2.1 Is the study design suitable for the objectives?

yes

2.2 Who / what was studied?

The objective is to determine, based on retrospective cohort study, if prehospital administration of IV fluids is superior

2.3 Was a control group used if appropriate?

There was not a control group, as both tend to be common practice

2.4 Were outcomes defined at the start of the study?

Outcomes studied were mortality of the patients.

2.5 Was this the right sample to answer the objectives?

Yes, the National Trauma Data Bank

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

Yes, the study have a very large sample size at 776,734. Not needed

2.7 Were all subjects accounted for?

Being a retrospective study, yes

2.8 Were all appropriate outcomes considered?

yes

2.9 Has ethical approval been obtained if appropriate?

yes

3 Measurement and observation

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

yeah, the outcomes measured mortality. Possible outcomes were survival vs. death

3.2 Was the assessment of outcomes blinded?

no, it was a retrospective cohort

3.3 Was follow up sufficiently long and complete?

N/A

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?

yes

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

yes, the paper did a good job of breaking down the results into smaller cohorts based on everything from mode/method of trauma to socioeconomic data of patients

4.3 How large are the effects within a specified time?

The study used 5 years worth of data from the American College of Surgeons National Trauma Data Base which houses approximately 1.5 million records from over 600 US trauma centers

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

5.3 Are any statistics correctly performed and interpreted?

yes

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?

I think there may be some bias towards the no prearrival extra procedures or "scoop and run" technique. As most emergency physicians think that, though EMS does an excellent job, most traumas, especially serious ones, require the expertise and knowledge of a trained physician.

7 Interpretation

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

yes

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

level II

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?

I believe it would be hard to change any of the methods, as he NTDB only has the information that is has, and any other information would have to be examined case by case.

8.2 What aids to implementation exist?

the Annals of Surgery National Trauma Database has data from over 600 trauma centers in the US

8.3 What barriers to implementation exist?

The NTDB does not have pre-arrival information for all patients.

8.4 Are the study patients similar to your own?

yes

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

Yes, the evidence shows that the pre-hospital administration of IV fluids in trauma patients is, in many cases, detrimental to the patients and increases mortality.