Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary.

Abstract

A short cut review was carried out to establish whether electrical stimulation had any advantages over facial exercises in promoting recovery after Bell’s palsy. Altogether 270 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 50 year old presents with Bell’s palsy. You have heard that physiotherapy is an effective treatment but wonder whether facial exercises produce a better outcome than treatment with electrical stimulation. Three part question In [facial nerve palsy] are [facial exercises better than electrical stimulation] at improving [time to function/facial symmetry]? Search strategy Medline and CINAHL 1966–06/02, AMED 1985–04/02 using the OVID interface. Medline and CINAHL: [{facial nerve palsy.mp OR exp facial paralysis OR exp bells palsy}] AND [“trophic stimulation”.mp OR exp physical therapy techniques OR “physiotherapy”.mp OR exp electric stimulation/ OR exp electric stimulation therapy/ OR “electrical stimulation”.mp OR electrotherapy.mp}] LIMIT to human AND English. AMED: {exp peripheral nerve disease} AND {exp electrotherapy}. Search outcome Medline and CINAHL: 253 papers were identified, AMED: 17 papers found 11 of which were relevant, but 10 papers were excluded as these described electromyographic feedback (EMG feedback training), which is not a form of electrical stimulation. The remaining paper is shown in table 1. Comment(s) No papers were found that involved physiotherapy treatment of Bell’s palsy in the acute setting. The above paper describes significant differences in the outcomes used for patients with long term facial nerve palsy using electrical stimulation, however this was not a rigorous study. c CLINICAL BOTTOM LINE There is no evidence to suggest that either exercises or electrical stimulation is beneficial to patients with acute Bell’s palsy. Evidence does exist to justify the use of electrical stimulation in patients with long term Bell’s palsy, although the study could have been more rigorous. Farragher D, Kidd GL, Tallis R. Eutrophic stimulation for Bell’s palsy. Clinical Rehabilitation 1987;1:265–71. White cell count and diagnosing appendicitis in children Report by Robert Williams, Clinical Fellow Checked by Kevin Mackway-Jones, Professor Abstract A short cut review was carried out to establish whether a single white cell count has clinical utility in the diagnosis of acute 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.A short cut review was carried out to establish whether a single white cell count has clinical utility in the diagnosis of acute 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 Electrical stimulation and Bell’s palsy c White cell count and diagnosing appendicitis in children c White cell count and diagnosing appendicitis in adults c Serum amylase or lipase to diagnose pancreatitis in patients presenting with abdominal pain c Management of acute ethylene glycol poisoning c Bed rest after lumbar puncture c Difficult intubation, the bougie and the stylet c To stab or slash: the percutaneous dilatation or standard surgical approach to cricothyroidotomy in prehospital care K Mackway-Jones Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones@man.ac.uk 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. 428 www.emjonline.com group.bmj.com on December 18, 2017 Published by http://emj.bmj.com/ Downloaded from