Best Evidence Topics

Randomised control trial

Campbell SG, Marrie TJ, Anstey R et al.
Utility of blood cultures in the management of adults with community acquired pneumonia discharged from the emergency department.
Emerg Med J.
  • Submitted by:Kevin Mackway-Jones - Professor in Emergency Medicine
  • Institution:Manchester Royal Infirmary
  • Date submitted:20th January 2004
Before CA, i rated this paper: 5/10
1 Objectives and hypotheses
1.1 Are the objectives of the study clearly stated?
  Yes - To assess the clinical value of blood cultures in the management of adult patients discharged from the emergency department with a diagnosis of community acquired pneumonia
2 Design
2.1 Is the study design suitable for the objectives
2.2 Who / what was studied?
  Patients with positive blood culture from 'CapitaL study'
2.3 Was this the right sample to answer the objectives?
2.4 Is the study large enough to achieve its objectives? Have sample size estimates been performed?
  No and No
2.5 Were all subjects accounted for?
2.6 Were all appropriate outcomes considered?
2.7 Has ethical approval been obtained if appropriate?
2.8 Were the patients randomised between treatments?
  No (between treatment arms of CapitaL study)
2.9 How was randomisation carried out?
2.10 Are the outcomes clinically relevant?
3 Measurement and observation
3.1 Is it clear what was measured, how it was measured and what the outcomes were?
  Yes - positive BC, readmission, changes in treatment > 24 hours
3.2 Are the measurements valid?
3.3 Are the measurements reliable?
  No - to note review only study proforma
3.4 Are the measurements reproducible?
3.5 Were the patients and the investigators blinded?
4 Presentation of results
4.1 Are the basic data adequately described?
4.2 Were groups comparable at baseline?
4.3 Are the results presented clearly, objectively and in sufficient detail to enable readers to make their own judgement?
4.4 Are the results internally consistent, i.e. do the numbers add up properly?
4.5 Were side effects reported?
5 Analysis
5.1 Are the data suitable for analysis?
5.2 Are the methods appropriate to the data?
5.3 Are any statistics correctly performed and interpreted?
6 Discussion
6.1 Are the results discussed in relation to existing knowledge on the subject and study objectives?
6.2 Is the discussion biased?
7 Interpretation
7.1 Are the authors' conclusions justified by the data?
  See above
7.2 What level of evidence has this paper presented? (using CEBM levels)
  4 - diagnostic
7.3 Does this paper help me answer my problem?
After CA, i rated this paper: 3/10
8 Implementation
8.1 Can any necessary change be implemented in practice?
8.2 What aids to implementation exist?
  CAP policy
8.3 What barriers to implementation exist?