BEST EVIDENCE TOPIC REPORTS Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary

A short cut review was carried out to establish whether swimmer’s views were better than superior oblique views at visualising the C7/T1 junction. Eleven papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of this best paper are tabulated. A clinical bottom line is stated. Clinical scenario A 36 year old man is brought to the emergency department after a road traffic accident. He complains of neck pain. A “pulled” lateral is taken, but fails to show the C7/T1 junction. You wonder whether a pair of supine oblique views or a swimmer’s view would be best to visualise this region. Three part question In a [trauma patient in whom standard lateral views of the cervical spine are inadequate] is a [swimmer’s view better than supine oblique views] at [visualising the C7/T1 junction]? Search strategy Medline 196607/02 using the OVID interface. [supine oblique.mp OR trauma oblique.mp OR swimmers view.mp OR twining.mp] AND [exp X-Rays OR x-ray$.mp or radiograph.mp OR exp radiography OR radiography.mp] AND [exp cervical vertebrae OR cervical spine.mp OR exp neck injuries OR neck injur$.mp OR cervicothoracic junction.mp.] LIMIT to human AND English. Search outcome Altogether 11 papers were found of which only one was relevant to the original question (see table 1). Best evidence topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practicing clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. The BETs published below were first reported at the Critical Appraisal Journal Club at the Manchester Royal Infirmary or placed on the BestBETs web site. Each BET has been constructed in the four stages that have been described elsewhere. The BETs shown here together with those published previously and those currently under construction can be seen at http://www.bestbets.org Eight BETs are included in this issue of the journal. c Swimmers view or supine oblique views to visualise the cervicothoracic junction c Computed tomography and the exclusion of upper cervical spine injury in trauma patients with altered mental state c Antibiotics in compound depressed skull fractures c Antibiotics in patients with isolated chest trauma requiring chest drains c Lignocaine (lidocaine) premedication before rapid sequence induction in head injuries c Ultrasound or computed tomography in paediatric blunt abdominal trauma c Routine use of antibiotic ointment and wound healing c Factor VIIa for intractable blood loss in trauma K Mackway-Jones Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; [email protected] 1 Carley SD, Mackway-Jones K, Jones A, et al. Moving towards evidence based emergency medicine: use of a structured critical appraisal journal club. J Accid Emerg Med 1998;15:220–2. 2 Mackway-Jones K, Carley SD, Morton RJ, et al. The best evidence topic report: A modified CAT for summarising the available evidence in emergency medicine. J Accid Emerg Med 1998;15:222–6. 3 Mackway-Jones K, Carley SD. bestbets.org: Odds on favourite for evidence in emergency medicine reaches the worldwide web. J Accid Emerg Med 2000;17:235–6.