An Evidence-Based Medicine Process to Determine Outcomes After Cervical Spine Trauma

Spine ◽  
2012 ◽  
Vol 37 (18) ◽  
pp. E1140-E1147 ◽  
Author(s):  
Peter Lewkonia ◽  
Christian DiPaola ◽  
Rowan Schouten ◽  
Vanessa Noonan ◽  
Marcel Dvorak ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Cervical Spine Trauma ◽  
Spine Trauma ◽  
Based Medicine

scholarly journals Management of patients with cervical spine trauma in the emergency department: a systematic critical appraisal of guidelines with a view to developing standardized strategies for clinical practice

2021 ◽  
Author(s):  
Elisa Gesu ◽  
Pietro Bellone ◽  
Mattia Bonzi ◽  
Giulio Andrea Bertani ◽  
Barbara Brignolo Ottolini ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cervical Spine ◽  
Critical Appraisal ◽  
A Priori ◽  
Complete Agreement ◽  
Evidence Based ◽  
Cervical Spine Trauma ◽  
Spine Trauma ◽  
Trauma Algorithm

AbstractSeveral guidelines on the evaluation of patients with suspected cervical spine trauma in the Emergency Department (ED) exist. High heterogeneity between different guidelines has been reported. Aim of this study was to find areas of agreement and disagreement between guidelines, to identify topics in which further research is needed and to provide an evidence-based cervical spine trauma algorithm for ED physicians. The three most relevant guidelines published on cervical spine trauma in the last 10 years were selected screening websites of the main scientific societies and through the comparison of a normalized Google Scholar and SCOPUS citation index. We compared the selected guidelines through seven a-priori defined questions. In case of disagreement between the guidelines or if the quality of evidence appeared low, evidence from published systematic reviews on the topic was added to build an evidence-based algorithm for approach to spinal trauma in the ED. The three selected guidelines were: NICE 2016, Eastern Association for the Surgery of Trauma 2009 and American Association of Neurological Surgeons and Congress of Neurological Surgeons 2013. We found complete agreement on one question, partial agreement for one questions, no agreement for two questions, while agreement was not assessable for 3 questions. The agreement between different guidelines and the evidence on which recommendations are based is low. An attempt to build an evidence-based algorithm has been made. More studies are needed on many topics.

scholarly journals The case for the future role of evidence-based medicine in the management of cervical spine injuries, with or without fractures

2019 ◽  
Vol 31 (4) ◽  
pp. 457-463 ◽  
Author(s):  
Mark N. Hadley ◽  
Beverly C. Walters
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Evidence Based Medicine ◽  
Treatment Strategies ◽  
Evidence Based ◽  
Cervical Fracture ◽  
Medical Evidence ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Based Medicine

The authors believe that the standardized and systematic study of immobilization techniques, diagnostic modalities, medical and surgical treatment strategies, and ultimately outcomes and outcome measurement after cervical spinal trauma and cervical spinal fracture injuries, if performed using well-designed medical evidence–based comparative investigations with meaningful follow-up, has both merit and the remarkable potential to identify optimal strategies for assessment, characterization, and clinical management. However, they recognize that there is inherent difficulty in attempting to apply evidence-based medicine (EBM) to identify ideal treatment strategies for individual cervical fracture injuries. First, there is almost no medical evidence reported in the literature for the management of specific isolated cervical fracture subtypes; specific treatment strategies for specific fracture injuries have not been routinely studied in a rigorous, comparative way. One of the vulnerabilities of an evidenced-based scientific review in spinal cord injury (SCI) is the lack of studies in comparative populations and scientific evidence on a given topic or fracture pattern providing level II evidence or higher. Second, many modest fracture injuries are not associated with vascular or neural injury or spinal instability. The application of the science of EBM to the care of patients with traumatic cervical spine injuries and SCIs is invaluable and necessary. The dedicated multispecialty author groups involved in the production and publication of the two iterations of evidence-based guidelines on the management of acute cervical spine and spinal cord injuries have provided strategic guidance in the care of patients with SCIs. This dedicated service to the specialty has been carried out to provide neurosurgical colleagues with a qualitative review of the evidence supporting various aspects of care of these patients. It is important to state and essential to understand that the science of EBM and its rigorous application is important to medicine and to the specialty of neurosurgery. It should be embraced and used to drive and shape investigations of the management and treatment strategies offered patients. It should not be abandoned because it is not convenient or it does not support popular practice bias or patterns. It is the authors’ view that the science of EBM is essential and necessary and, furthermore, that it has great potential as clinician scientists treat and study the many variations and complexities of patients who sustain acute cervical spine fracture injuries.

Development of an evidence-based guideline for imaging in cervical spine trauma

2003 ◽  
Vol 47 (3) ◽  
pp. 240-246 ◽  
Author(s):  
Stacy K Goergen ◽  
Christina Fong ◽  
Kim Dalziel ◽  
Gabby Fennessy
Keyword(s):  
Cervical Spine ◽  
Evidence Based ◽  
Cervical Spine Trauma ◽  
Spine Trauma ◽  
Evidence Based Guideline

Evidence-based medicine

2002 ◽  
Vol 44 (07) ◽  
Author(s):  
Peter G Procopis
Keyword(s):  
Evidence Based Medicine ◽  
Evidence Based ◽  
Based Medicine

Cholangiokarzinome

Praxis ◽  
2002 ◽  
Vol 91 (34) ◽  
pp. 1352-1356
Author(s):  
Harder ◽  
Blum
Keyword(s):  
Supportive Care ◽  
Evidence Based Medicine ◽  
Best Supportive Care ◽  
Evidence Based ◽  
Systemische Chemotherapie ◽  
Chirurgische Resektion ◽  
Multimodale Therapiekonzepte ◽  
Based Medicine

Cholangiokarzinome oder cholangiozelluläre Karzinome (CCC) sind seltene Tumoren des biliären Systems mit einer Inzidenz von 2–4/100000 pro Jahr. Zu ihnen zählen die perihilären Gallengangskarzinome (Klatskin-Tumore), mit ca. 60% das häufigste CCC, die peripheren (intrahepatischen) Cholangiokarzinome, das Gallenblasenkarzinom, die Karzinome der extrahepatischen Gallengänge und das periampulläre Karzinom. Zum Zeitpunkt der Diagnose ist nur bei etwa 20% eine chirurgische Resektion als einzige kurative Therapieoption möglich. Die Lebertransplantation ist wegen der hohen Rezidivrate derzeit nicht indiziert. Die Prognose von nicht resektablen Cholangiokarzinomen ist mit einer mittleren Überlebenszeit von sechs bis acht Monaten schlecht. Eine wirksame Therapie zur Verlängerung der Überlebenszeit existiert aktuell nicht. Die wichtigste Massnahme im Rahmen der «best supportive care» ist die Beseitigung der Cholestase (endoskopisch, perkutan oder chirurgisch), um einer Cholangitis oder Cholangiosepsis vorzubeugen. Durch eine systemische Chemotherapie lassen sich Ansprechraten von ca. 20% erreichen. 5-FU und Gemcitabine sind die derzeit am häufigsten eingesetzten Substanzen, die mit einer perkutanen oder endoluminalen Bestrahlung kombiniert werden können. Multimodale Therapiekonzepte können im Einzellfall erfolgreich sein, müssen jedoch erst in Evidence-Based-Medicine-gerechten Studien evaluiert werden, bevor Therapieempfehlungen für die Praxis formuliert werden können.

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