Evidence-Based Medicine

What counts as a normal respiratory or heart rate in a child? This 2015 appraisal examines emergency department centile data, compares published reference ranges and considers how rounded measurements and uneven age groups affect interpretation. It asks how confidently these observations can inform clinical assessment.

Persistent fast breathing in an otherwise well baby can be difficult to interpret. This 2015 review explores respiratory-rate measurement, clinical context and possible underlying causes, highlighting the importance of reassessment and follow-up when the initial examination or investigations do not explain the finding.

Do vein-finding devices improve first-attempt cannulation in children? This 2015 appraisal compares ultrasound, near-infrared imaging and standard practice in a Canadian emergency department trial. It examines staff training, sample size and generalisability, asking whether better vein visualisation translates into better outcomes.

Could patient-controlled analgesia improve ongoing pain relief after arrival in the emergency department? This 2015 journal club examines the two PASTIES trials, comparing abdominal pain and traumatic injury, and discusses their differing results, pragmatic design and the limitations of unblinded pain assessment.

Does therapeutic hypothermia improve outcomes after cardiac arrest in children? This 2015 journal club examines a trial comparing cooling with active temperature control after out-of-hospital arrest, exploring neurological outcomes, confidence intervals, study limitations and why a non-significant result does not establish that two treatments are equivalent.

What happens when James Lind’s scurvy experiment meets a modern critical appraisal checklist? Written for International Clinical Trials Day 2015, this deliberately playful review uses the historic study to explain randomisation, outcome definitions, statistical uncertainty and how expectations of clinical research have changed.