ANNALS OF EMERGENCY MEDICINE JOURNAL CLUB
Speed Does Matter: Police Transport of Critical Trauma Victims May 2014 Annals of Emergency Medicine Journal Club Guest Contributors Samuel J. Stratton, MD, MPH; Atilla Uner, MD, MPH 0196-0644/$-see front matter Copyright © 2014 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2014.03.001
Editor’s Note: You are reading the 39th installment of Annals of Emergency Medicine Journal Club. This Journal Club refers to the Band et al1 article published in the May 2014 edition. This bimonthly feature seeks to improve the critical appraisal skills of emergency physicians and other interested readers through a guided critique of actual Annals of Emergency Medicine articles. Each Journal Club will pose questions that encourage readers—be they clinicians, academics, residents, or medical students—to critically appraise the literature. During a 2- to 3-year cycle, we plan to ask questions that cover the main topics in research methodology and critical appraisal of the literature. To do this, we will select articles that use a variety of study designs and analytic techniques. These may or may not be the most clinically important articles in a specific issue, but they are articles that serve the mission of covering the clinical epidemiology curriculum. Journal Club entries are published in 2 phases. In the first phase, a list of questions about the article is published in the issue in which the article appears. Questions are rated “novice,” ( ) “intermediate,” ( ), and “advanced” ( ) so that individuals planning a journal club can assign the right question to the right student. The answers to this journal club will be published in the October 2014 issue. US residency directors will have immediate access to the answers through the Council of Emergency Medicine Residency Directors Share Point Web site. International residency directors can gain access to the questions by going to http://www. emergencymedicine.ucla.edu/annalsjc/ and following the directions. Thus, if a program conducts its journal club within 5 months of the publication of the questions, no one will have access to the published answers except the residency director. The purpose of delaying the publication of the answers is to promote discussion and critical review of the literature by residents and medical students and discourage regurgitation of the published answers. It is our hope that the Journal Club will broaden Annals of Emergency Medicine’s appeal to residents and medical students. We are interested in receiving feedback about this feature. Please e-mail [email protected] with your comments.
DISCUSSION POINTS 1.
2.
Describe the study goal and researchers’ conclusions. What is the difference between nonmedical police transport and emergency medical services (EMS) transport? A. For this retrospective study, patients with penetrating trauma were divided into 2 groups: those transported by
648 Annals of Emergency Medicine
police and those transported by EMS. How might selection bias affect study results?
3.
4.
B. What are the characteristics of the emergency management of penetrating trauma of the thorax that support the study results? What aspects of the emergency management for penetrating trauma of the thorax contradict the logic of the study results? Which characteristics of police transport could EMS emulate and which cannot be emulated? A. The outcome measure for this study was inhospital mortality. Is this outcome measure optimal? Are there other outcome measures that would be of interest? What would be the obstacles to studying them? B. The authors report that 4.7% of the initial study population could not be included in the study because of missing information about transport mode (police versus EMS). How could the data have been analyzed to determine whether this 4.7% missing data biased study results? C. Are there other acute emergency conditions that may benefit from incorporating rapid nonmedical transport into a community emergency response system? An adjustment of case mix among study subjects was made with the Charlson comorbidity index. Was this an appropriate adjustment technique for victims of penetrating trauma? The Charlson index was modified to conduct the study; how may this affect the validity of the results?
Section editors: Tyler W. Barrett, MD, MSCI; David L. Schriger, MD, MPH Author affiliations: From the UCLA Fielding School of Public Health, Los Angeles, CA (Stratton); and the David Geffen School of Medicine at UCLA, Los Angeles, CA (Stratton, Uner).
REFERENCE 1. Band RA, Salhi RA, Holena DN, et al. Severity-adjusted mortality in trauma patients transported by police. Ann Emerg Med. 2014;63:608-614.
Volume 63, no. 5 : May 2014
Speed Does Matter: Police Transport of Critical Trauma Victims May 2014 Annals of Emergency Medicine Journal Club Guest Contributors Samuel J. Stratton, MD, MPH; Atilla Uner, MD, MPH 0196-0644/$-see front matter Copyright © 2014 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2014.03.001
Editor’s Note: You are reading the 39th installment of Annals of Emergency Medicine Journal Club. This Journal Club refers to the Band et al1 article published in the May 2014 edition. This bimonthly feature seeks to improve the critical appraisal skills of emergency physicians and other interested readers through a guided critique of actual Annals of Emergency Medicine articles. Each Journal Club will pose questions that encourage readers—be they clinicians, academics, residents, or medical students—to critically appraise the literature. During a 2- to 3-year cycle, we plan to ask questions that cover the main topics in research methodology and critical appraisal of the literature. To do this, we will select articles that use a variety of study designs and analytic techniques. These may or may not be the most clinically important articles in a specific issue, but they are articles that serve the mission of covering the clinical epidemiology curriculum. Journal Club entries are published in 2 phases. In the first phase, a list of questions about the article is published in the issue in which the article appears. Questions are rated “novice,” ( ) “intermediate,” ( ), and “advanced” ( ) so that individuals planning a journal club can assign the right question to the right student. The answers to this journal club will be published in the October 2014 issue. US residency directors will have immediate access to the answers through the Council of Emergency Medicine Residency Directors Share Point Web site. International residency directors can gain access to the questions by going to http://www. emergencymedicine.ucla.edu/annalsjc/ and following the directions. Thus, if a program conducts its journal club within 5 months of the publication of the questions, no one will have access to the published answers except the residency director. The purpose of delaying the publication of the answers is to promote discussion and critical review of the literature by residents and medical students and discourage regurgitation of the published answers. It is our hope that the Journal Club will broaden Annals of Emergency Medicine’s appeal to residents and medical students. We are interested in receiving feedback about this feature. Please e-mail [email protected] with your comments.
DISCUSSION POINTS 1.
2.
Describe the study goal and researchers’ conclusions. What is the difference between nonmedical police transport and emergency medical services (EMS) transport? A. For this retrospective study, patients with penetrating trauma were divided into 2 groups: those transported by
648 Annals of Emergency Medicine
police and those transported by EMS. How might selection bias affect study results?
3.
4.
B. What are the characteristics of the emergency management of penetrating trauma of the thorax that support the study results? What aspects of the emergency management for penetrating trauma of the thorax contradict the logic of the study results? Which characteristics of police transport could EMS emulate and which cannot be emulated? A. The outcome measure for this study was inhospital mortality. Is this outcome measure optimal? Are there other outcome measures that would be of interest? What would be the obstacles to studying them? B. The authors report that 4.7% of the initial study population could not be included in the study because of missing information about transport mode (police versus EMS). How could the data have been analyzed to determine whether this 4.7% missing data biased study results? C. Are there other acute emergency conditions that may benefit from incorporating rapid nonmedical transport into a community emergency response system? An adjustment of case mix among study subjects was made with the Charlson comorbidity index. Was this an appropriate adjustment technique for victims of penetrating trauma? The Charlson index was modified to conduct the study; how may this affect the validity of the results?
Section editors: Tyler W. Barrett, MD, MSCI; David L. Schriger, MD, MPH Author affiliations: From the UCLA Fielding School of Public Health, Los Angeles, CA (Stratton); and the David Geffen School of Medicine at UCLA, Los Angeles, CA (Stratton, Uner).
REFERENCE 1. Band RA, Salhi RA, Holena DN, et al. Severity-adjusted mortality in trauma patients transported by police. Ann Emerg Med. 2014;63:608-614.
Volume 63, no. 5 : May 2014
