OPERATIVE TREATMENT OF ACUTE UNSTABLE CHEST WALL INJURIES DOES NOT REDUCE PAIN OR IN-HOSPITAL OPIOID REQUIREMENTS: A MULTICENTRED RANDOMIZED CONTROLLED TRIAL
Notice bibliographique
Résumé
A previous randomized clinical trial evaluating operative versus nonoperative treatment of acute unstable chest wall injuries revealed more ventilator free days in operatively treated patients who were ventilated at the time of randomization. Our goal was to perform a secondary analysis to evaluate pain, and post-injury opioid requirements of operatively and non-operatively treated unstable chest wall injuries. Data from a previous multicenter prospective randomized clinical trial conducted from 2011-2019 were analyzed. Patients sustaining acute, unstable chest wall injuries were randomized to operative or non-operative treatment. In hospital pain medication logs were evaluated and daily morphine milligram equivalents (MME) were calculated. MME were compared between the two treatment groups. A linear mixed model analyzed the MME over time between the two groups for hospital days 1 through 14. A multiple linear regression analysis was then performed to determine variables associated with patient's average MME/day while in hospital. Variables analyzed included treatment group, injury severity scores (ISS), GCS at randomization, ventilation status at randomization, epidural, ICU length of stay and number of surgeries in the first 28 days. Two-hundred and seven patients were randomized in the original trial - 99 patients to non-operative treatment and 108 to operative treatment. MME data was available for 200 patients. There was no evidence of a difference in pain medication usage between the two groups at any of the time points examined (p=0.477). There was no clinical difference between generalized pain, chest wall pain, chest wall tightness or shortness of breath at any time post-operatively in patients treated surgically or non-operatively. This secondary analysis of a randomized clinical trial suggests that operative treatment of patients with unstable chest wall injuries does not decrease in-hospital daily opioid requirements. There was also no improvement of generalized pain, chest wall pain, chest wall tightness or shortness of breath symptoms. Surgical treatment of these injuries for pain management does not appear to be supported by the results of this study. Further work is needed to identify factors that are associated with increase in pain and opioid requirements.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».