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Thu Oct 12 07:27:57 BST 2006

Disillusioned?  Hardly.  I read the Cochrane study.  That's why I brought it
up.

There are cases, very limited but mostly breathtakingly obvious, where a
lack of supportive literature should not divert us from logical practices.
There is no literature supporting spinal immobilization, thus Cochrane has
fueled any number of proposals for abandoning it.  I'm doubtful there's much
contemporary research on direct pressure for hemorrhage control, or
supplemental oxygen in the prehospital phase, or not running with scissors.
This sort of obverse anti-meta-analytical argument should be taken for what
it's worth, lest patients suffer for our radical absolutism.

Where common sense is unsupported by an evidentiary basis, we should
probably err on the side of common sense until evidence actually discourages
it.

Just me, just now.  Forgive me, Dr. Frykberg, for I have sinned.

Pret Bjorn

----- Original Message -----
From: <tch at sun.ac.za>
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Sent: Thursday, October 12, 2006 5:11 AM
Subject: RE: RE: ATLS training

Juan and Pret

Sorry to disillusion you, but Cochrane has already done a trauma / ATLS
review: Shakiba H, Dinesh S, Anne MK. Advanced trauma life support training
for hospital staff. Cochrane Database Syst Rev. 2004;(3):CD004173. Review.

Text of abstract:
BACKGROUND: Injury is responsible for an increasing global burden of death
and disability. As a result, new models of trauma care have been developed.
Many of these, though initially developed in high-income countries, are now
being adopted in low and middle-income countries (LMICs). One such trauma
care model is advanced trauma life support (ATLS) training in hospitals,
which is being promoted in LMICs as a strategy for improving outcomes for
victims of trauma. However, the evidence of effectiveness for this health
service intervention, in either HIC or LMIC settings, has not been
rigorously tested using methodology such as a systematic review. OBJECTIVES:
To quantify the effectiveness of hospitals with an ATLS-trained trauma
response system versus hospitals without such a response system in reducing
mortality and morbidity following trauma. SEARCH STRATEGY: We searched the
Cochrane Injuries Group Specialised Register (CIGSR), the Cochrane
Controlled Trials Register (CCTR), MEDLINE & PubMed, EMBASE, CINAHL, Science
Citation Index, National Research Register, and web-based trials databases
such as Current Controlled Trials. We checked references of background
papers and contacted authors to identify additional published or unpublished
data. SELECTION CRITERIA: Randomised controlled trials, controlled trials,
controlled before- and- after studies comparing effectiveness of hospitals
with an ATLS-trained trauma response system versus hospitals without such a
response system in reducing mortality and morbidity following trauma. DATA
COLLECTION AND ANALYSIS: Two reviewers independently applied eligibility
criteria to trial reports for inclusion and to extract data. MAIN RESULTS:
There is a limited literature relating to this topic but none of the studies
identified met the inclusion criteria for this review. REVIEWERS'
CONCLUSIONS: There is no clear evidence that ATLS training (or similar)
impacts on the outcome for victims of trauma, although there is some
evidence that educational initiatives improve knowledge of what to do in
emergency situations. Further, there is no evidence that trauma management
systems incorporating ATLS training impact positively on outcome. Future
research should concentrate on the evaluation of trauma systems
incorporating ATLS, both within hospitals and at the health system level, by
using rigorous research designs.

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