Journal Club Summaryepistaxis

Methodology Score: 2/5                 

Usefulness Score: 3.5/5

Zahed R, Moharamzadeh P, Alizadeharasi S, Ghasemi A, Saeedi M.Am J Emerg Med.2013 Sep;31(9):1389-92

This single centre, ED based, parallel group randomized control trial found that the topical application of an injectable form of tranexamic acid (TXA) was better than anterior nasal packing (ANP) for halting bleeding within the first 10 minutes (ARR=40%, P=<0.001) and discharging the patient from the department within the first 2 hours (ARR=89%,  P=<0.001). The DEM journal club identified several errors in the paper which compromised the validity of the results; however, the overall cost effectiveness (500mg TXA at The Ottawa Hospital = $5.90) and the potential for significantly decreasing patient discomfort made this low-risk intervention very appealing to attendees. 
By:Dr. Nicholas Costain
(Presented January 2014) 

Epi lesson: p values in baseline characteristic tables 

Whether or not to present p values in Table 1 of baseline characteristics for an RCT is controversial. The risk in doing so, however, is that you assume that a significant difference between both groups highlighted by a statistically significant p value means that there was a problem with the randomization procedures. If there are a large number of characteristics, it is increasingly likely that a significant p value is due to chance rather than a problem with randomization. More important is to examine whether there are any clinically significant differences between both groups and then to ask yourself whether this characteristic is likely to influence the primary outcome, requiring an adjustment in the analysis. 
By: Dr. Lisa Calder