Best Evidence Topics


M.Donald, N.Marlow, E.Swinburn, M.Wu
Emergency department management of home iv antibiotic therapy for cellulitis
October 2005; 715-717
  • Submitted by:Gabrielle May - ST3 Emergency Medicine
  • Institution:Booth Hall Children's Hospital
  • Date submitted:1st February 2006
Before CA, i rated this paper: 2/10
1 Objectives and hypotheses
1.1 Are the objectives of the study clearly stated?
  Yes - evaluation of safety and efficacy of using iv cephazolin as first line Abx for treatment of cellulitis
2 Design
2.1 Is the study design suitable for the objectives?
2.2 Who / what was studied?
2.3 Was a control group used if appropriate?
2.4 Were outcomes defined at the start of the study?
2.5 Was this the right sample to answer the objectives?
2.6 Is the study large enough to achieve its objectives? Have sample size estimates been performed?
2.7 Were all subjects accounted for?
2.8 Were all appropriate outcomes considered?
2.9 Has ethical approval been obtained if appropriate?
3 Measurement and observation
3.1 Is it clear what was measured, how it was measured and what the outcomes were?
  readmission rate is measured - as a marker of efficacy
no other raw data given
3.2 Was the assessment of outcomes blinded?
3.3 Was follow up sufficiently long and complete?
  not mentioned - only end point was re-admission and we are not told how many days this was after the instigation of treatment
3.4 Are the measurements valid?
  rates of readmission is a valid measurent - from computer records
3.5 Are the measurements reliable?
  rates of readmission is reliable
3.6 Are the measurements reproducible?
  yes - on computer database
4 Presentation of results
4.1 Are the basic data adequately described?
  no - only location of cellulitis and rates of readmission looked at
4.2 Are the results presented clearly, objectively and in sufficient detail to enable readers to make their own judgement?
  only one chart of interest - rates of readmission
information re safety given in prose
only the mean duration of therapy is given
no info re the number of patients excluded fron the sample
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, for the 124 in the sample
5 Analysis
5.1 Are the data suitable for analysis?
  only data really suitable (and given) would be that of readmission rates
5.2 Are the methods appropriate to the data?
  the only analysis done is a bar chart showing readmission and successful treatment numbers, and the mean duration of lenght of treatment
5.3 Are any statistics correctly performed and interpreted?
  not done
6 Discussion
6.1 Are the results discussed in relation to existing knowledge on the subject and study objectives?
  Yes, several studies looking at the use of iv abx in the out patient setting are cited
6.2 Is the discussion biased?
only subjects that do not fit the exclusion criteria are used
the length of time on antibiotics is not shown - we are just told that treatment was successful at some point
definition of cellulitis?
7 Interpretation
7.1 Are the author's conclusions justified by the data?
  no - the objective is re safety and efficacy as first line other methods are discussed ?po abx ?another iv abx.
There is no definition of efficacy and safety at the start so it is very difficult for the trial top prove anything
7.2 What level of evidence has this paper presented? (using CEBM levels)
7.3 Does this paper help me to answer my problem?
After CA, i rated this paper: 5/10
8 Implementation
8.1 Can any necessary change be implemented in practice?
  not at present
8.2 What aids to implementation exist?
8.3 What barriers to implementation exist?
  There is no set up to administer iv abx at home
There is no proof that iv cephazolin would be first choice
Oral Abx?
I am not what percentage of people that present to the ED with cellulitis would be eligible for this treatment
8.4 Are the study patients similar to your own?
  Yes, ED patients with cellulitis. Both sexes with age range 16-97. However, small numbers and there may be cellulitis for different reasons - water injuries in Australia, IVDA associated in UK
8.5 Does the paper give any conclusions that will affect what you will offer or tell your patient?