Rapid Real Data

On a recent night I saw a critically ill, hypotensive woman with prior ectopic and periumbilical abdominal pain.

I completed my exam including a FAST scan, two saline lines running open with pressures at 60-70 systolic, and a call to OB as a heads-up.

Serum pregnancy test pending. I had just heard Michelle Lin, MD on EM:Rap talk about rapid bedside whole blood pregnancy test (using a urine pregnancy test kit) based on this article: “Substituting whole blood for urine in a bedside pregnancy test.” which showed as good or better efficacy then urine – in 10 minutes.

I inquired about getting this test at our facility, and the initial response was that this was a “VBI – very bad idea” based on this opinion blog post without references, as well as an informal survey of the decision maker’s peers.

I was floored that I had presented a compelling article for use of a cheap test, good efficacy, and rapid in the face of critical illness, and it was refuted with opinion. This is not isolated. I am excited that our medical practice is more and more based on evidence, and frustrated that the key obstacle to implementation is based not on science, but on preconceived notions and opinion.

This is not a critique of the opinion-based blog. This is a critique of not recognizing blog posts as opinion and how that differs from case controlled studies. I am, myself, statistically challenged, but this fundamental difference I understand. And reader, you should recognize that what I write here is 100% my opinion and you should not use this to base any medical decision. I also understand that research is messy, and that it can easily be misinterpreted. Then focus on the quality of the article and the evidence, and contrast it with similar journal articles.

My wife, who is statistically adept, works in public health for the state and she frequently has conversations about data and evidence that baffle me. My preconceived notion of public health is that they are the purveyors of cohort health data – analysis, interpretation, forecasting, recognition of patterns. Yet she describes a wide variance in the understanding in public health of data acquisition and evaluation (my words not hers) – basic concepts are lacking, and decisions are based on ancient mantras.

Ten years ago when I looked to Cochrane for advice, most of what I found was “further study needed.” Now, that landscape is changing, and I find more and more guidance on what does and does not work when subjected to high quality study. I feel as if evidence based medicine is actually better directing me today.

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