Case reports describing treatments in the emergency medicine literature: missing and misleading information
Case reports describing treatments in the emergency medicine literature: missing and misleading information
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DOI：
10.1186/1471-227x-9-10
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发表时间：
2009-01-01
影响因子：
2.5
通讯作者：
Heard, Kennon J.
中科院分区：
文献类型：
--
作者：
Richason, Tiffany P.;Paulson, Stephen M.;Heard, Kennon J.
背景资料：尽管随机试验和系统评价为指导医疗实践提供了“最佳证据”，但许多急诊医学期刊仍然发表病例报告（CR）。这些出版物中的报告质量尚未评估。目的：在这项研究中，我们试图确定充分报告患者、疾病、干预措施、共同干预措施、结局和其他关键信息的治疗相关病例报告的比例。方法：我们检索了2000- 2005年发表在4种急诊医学期刊上的CR，并根据其目的进行了分类（疾病描述、药物过量或药物不良反应、诊断试验或治疗效果）。治疗相关的CR进行了审查的存在或不存在的11个reportingelements.Results：所有告诉，1,316 CR被确定，其中，85（6.5%; 95 CI = 66，84）是关于内科或外科治疗。大多数包含对患者（99%; 95 CI = 95，100）、患者疾病的分期和严重程度（88%; 95 CI = 79，93）、干预（80%; 95 CI = 70，87）和治疗结局（90%; 95 CI = 82，95）的充分描述。较少CR报告患者的合并症（45%; 95 CI = 35，56）、合并用药（30%; 95 CI = 21，40）或联合干预（57%; 95 CI = 46，67）或提及任何可能的治疗副作用（33%; 95 CI = 24，44）。只有37%（95 CI = 19，38）讨论了有利结局的替代解释。仅29%（95 CI = 20，39）提到了治疗效果对其他患者的普遍性。只有2 CR（2.3%; 95 CI = 1，8）报告了“分母”（接受相同干预的患者数量，无论是否成功。结论：急诊医学期刊中与治疗相关的CR通常忽略有关治疗，共同干预，结果，概括性，因果关系和解释的关键细节。因此，这些信息可能会误导提供者，并且临床应用可能对患者护理不利。
Background: Although randomized trials and systematic reviews provide the "best evidence" for guiding medical practice, many emergency medicine journals still publish case reports (CRs). The quality of the reporting in these publications has not been assessed.Objectives: In this study we sought to determine the proportion of treatment-related case reports that adequately reported information about the patient, disease, interventions, cointerventions, outcomes and other critical information.Methods: We identified CRs published in 4 emergency medicine journals in 2000- 2005 and categorized them according to their purpose (disease description, overdose or adverse drug reactioin, diagnostic test or treatment effect). Treatment-related CRs were reviewed for the presence or absence of 11 reporting elements.Results: All told, 1,316 CRs were identified; of these, 85 (6.5%; 95CI = 66, 84) were about medical or surgical treatments. Most contained adequate descriptions of the patient (99%; 95CI = 95, 100), the stage and severity of the patient's disease (88%; 95CI = 79, 93), the intervention (80%; 95CI = 70, 87) and the outcomes of treatment (90%; 95CI = 82, 95). Fewer CRs reported the patient's comorbidities (45%; 95CI = 35, 56), concurrent medications (30%; 95CI = 21, 40) or co-interventions (57%; 95CI = 46, 67) or mentioned any possible treatment side-effects (33%; 95CI = 24, 44). Only 37% (95CI = 19, 38) discussed alternative explanations for favorable outcomes. Generalizability of treatment effects to other patients was mentioned in only 29% (95CI = 20, 39). Just 2 CRs (2.3%; 95CI = 1, 8) reported a "denominator" (number of patients subjected to the same intervention, whether or not successful.Conclusion: Treatment-related CRs in emergency medicine journals often omit critical details about treatments, co-interventions, outcomes, generalizability, causality and denominators. As a result, the information may be misleading to providers, and the clinical applications may be detrimental to patient care.