Bulletin of the NYU hospital for joint diseases
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Bull NYU Hosp Jt Dis · Jan 2008
The effects of alcohol on in-hospital mortality in drivers admitted after motor vehicle accidents.
The effects of alcohol on morbidity and mortality following motor vehicle accidents (MVAs) are controversial. This study was performed to address the effect of alcohol on in-hospital mortality for drivers in MVAs admitted to a trauma center before and after controlling for injury severity, safety device use, and patient demographics. ⋯ These results suggest the importance of carefully considering the consequences that falsely inlated ISS scores might have for patients with alcohol present. Future work should evaluate the possible inlation of ISS and attempt to reconcile different interpreta- tions of the effects that the presence of alcohol may have on MVA mortality based by jointly considering crash site and in-hospital data.
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The p-value is a widely used tool for inference in clinical studies. However, despite the numerous books and papers published on the basics of statistical inference and, thus, on the p-value, there still seems to be a need to highlight what message the p-value exactly contains (and what it does not). In this article, the basic concepts and the different misconceptions regarding the p-value will be highlighted and illustrated with a clinical trial in osteoarthritis. It will also be shown that the (95%) confidence interval is to be preferred over the p-value as a statistical inference tool.
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Bull NYU Hosp Jt Dis · Jan 2008
Risk of injury associated with the use of seat belts and air bags in motor vehicle crashes.
Although air bags have been reported to reduce passenger mortality in frontal collisions, they have also been reported as a cause of injury in motor vehicle collisions(MVCs). The purpose of this study was to evaluate a large cohort of patients involved in MVCs to determine mortality and the pattern of injuries associated with seat belt use and air bag deployment. Information on patients involved in MVCs from 1988 to 2004 was obtained from the National Trauma Data Bank (NTDB). ⋯ Air bags and seat belts used in combination decreased the risk of potentially fatal injuries, but increased the risk of lower extremity injuries (odds ratio, 1.35). The use of any type of restraint led to a decrease in the risk of injury or mortality in MVCs. Only half of all individuals in this study used any type of restraint device, which indicates the need for significant improvements in public health and safety seat belt utilization programs.
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When the aim of the randomized controlled trial (RCT) is to show that one treatment is superior to another, a statistical test is employed and the trial (test) is called a superiority trial (test). Often a nonsignificant superiority test is wrongly interpreted as proof of no difference between the two treatments. Proving that two treatments are equal in performance is impossible with statistical tools; at most, one can show that they are equivalent. ⋯ In this report, the three types of trials are compared, but the main focus is on the non-inferiority trial. Special attention is paid to the practical implications when setting up a non-inferiority trial. Illustrations are taken from a clinical trial in osteoarthritis and from thrombolytic research.
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Bull NYU Hosp Jt Dis · Jan 2008
Does a traction-internal rotation radiograph help to better evaluate fractures of the proximal femur?
The standard radiographic series for evaluation of a suspected hip fracture in most centers includes an anteroposterior (AP) radiograph of the pelvis, as well AP and cross-table lateral views of the hip. The natural femoral neck anteversion, as well as the fracture deformity, however, may make accurate fracture classification difficult. We have noted that inexperienced physicians sometimes misclassify hip fractures based on the initial radiographic series, which may lead to errors both in surgical planning and implant choice. At our institution, we routinely obtain a physician-assisted traction-internal rotation radiograph of the affected hip in all fractures of the proximal femur. The purpose of the current study was to examine the usefulness of the traction-internal rotation radiograph for the classification of hip fractures by junior residents in our department. ⋯ The routine addition of a traction-internal rotation radiograph increased the ability to accurately classify proximal femur fractures by junior residents in our department. This has a direct impact in accurate surgical planning and implant choice.