Cochrane Evidence Aid: resources for earthquakes

Water for wound cleansing

There is no evidence that using tap water to cleanse acute wounds in adults increases infection and some evidence that it reduces it. However there is not strong evidence that cleansing wounds per se increases healing or reduces infection. In the absence of potable tap water, boiled and cooled water as well as distilled water can be used as wound cleansing agents.  [Download PDF]  [Resumen en español]  [Evidence Update summary  (en español)]

Interventions for treating wrist fractures in children

Limited evidence supports the use of removable splintage for buckle fractures and challenges the traditional use of above-elbow casts after reduction of displaced fractures. Although percutaneous wire fixation prevents redisplacement, the effects on longer term outcomes including function are not established. [Download PDF]  [Resumen en español]

Bone grafts and bone substitutes for treating distal radial fractures in adults

Bone scaffolding may improve anatomical outcome compared with plaster cast alone but there is insufficient evidence to conclude on functional outcome and safety; or for other comparisons. [Download PDF]  [Resumen en español]

Pre-operative traction for hip fractures in adults

From the evidence available, the routine use of traction (either skin or skeletal) prior to surgery for a hip fracture does not appear to have any benefit. However, the evidence is also insufficient to rule out the potential advantages for traction, in particular for specific fracture types, or to confirm additional complications due to traction use. Given the continued lack of evidence for the use of pre-operative traction, the onus should now be on clinicians who persist in using pre-operative traction to either stop using it or to use it only in the context of a well-designed randomised controlled trial. [Download PDF]

Percutaneous pinning for treating distal radial fractures in adults

Though there is some evidence to support its use, the precise role and methods of percutaneous pinning are not established. The higher rates of complications with Kapandji pinning and biodegradable materials casts some doubt on their general use. [Download PDF]  [Resumen en español]

Interventions for treating proximal humeral fractures in adults

Early physiotherapy, without immobilisation, may be sufficient for some types of undisplaced fractures. It is unclear whether operative intervention, even for specific fracture types, will produce consistently better long term outcomes. [Download PDF]  [Resumen en español]

Interventions for isolated diaphyseal fractures of the ulna in adults

There is weak evidence that in people with minimally displaced isolated fracture of the ulna, cast immobilisation of the elbow may offer no short-term advantage in respect of pain relief or fracture union, and may be associated with longer delay in return to work, when compared with the use of a cast or brace that immobilises only the forearm. [Download PDF]  [Resumen en español]

External fixation versus conservative treatment for distal radial fractures in adults

There is some evidence to support the use of external fixation for dorsally displaced fractures of the distal radius in adults. Though there is insufficient evidence to confirm a better functional outcome, external fixation reduces redisplacement, gives improved anatomical results and most of the excess surgically-related complications are minor. [Download PDF]  [Resumen en español]

Conservative versus operative treatment for hip fractures in adults

Conservative treatment will be acceptable where modern surgical facilities are unavailable, and will result in a reduction in complications associated with surgery, but rehabilitation is likely to be slower and limb deformity more common. [Download PDF]  [Resumen en español]

Conservative interventions for treating distal radial fractures in adults

There remains insufficient evidence from randomised controlled trials to determine which methods of conservative treatment are the most appropriate for the more common types of distal radial fractures in adults. Therefore, at present, practitioners applying conservative management should use an accepted technique with which they are familiar, and which is cost-effective from the perspective of their provider unit. Patient preferences and circumstances, and the risk of complications should also be considered. [Download PDF]  [Resumen en español]

Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures

Antibiotic prophylaxis for closed fracture surgery is an effective intervention. Single dose intravenous prophylaxis is effective if the agent used provides tissue levels exceeding the minimum inhibitory concentration over a 12 hour period. If the antibiotic chosen has a short half-life which may not allow minimum inhibitory concentrations to be exceeded throughout the period from incision to wound closure, the use of multiple dose regimens using a 12 hour dosage schedule is a satisfactory alternative. [Download PDF]  [Resumen en español]

Colloids versus crystalloids for fluid resuscitation in critically ill patients

There is no evidence from randomised trials that resuscitation with colloids reduces the risk of death, compared to resuscitation with crystalloids, in patients with trauma, burns or following surgery. As colloids are not associated with an improvement in survival, and as they are more expensive than crystalloids, it is hard to see how their continued use in these patients can be justified outside the context of randomised trials. [Download PDF]  [Resumen en español]

Antifibrinolytic drugs for acute traumatic injury

Tranexamic acid safely reduces mortality in bleeding trauma patients without increasing the risk of adverse events. Further trials are needed to determine the effects of tranexamic acid in patients with isolated traumatic brain injury. [Dowlnoad PDF] [Listen to podcast]

Steroids for acute spinal cord injury

High-dose methylprednisolone steroid therapy is the only pharmacologic therapy shown to have efficacy in a phase three randomized trial when administered within eight hours of injury. One trial indicates additional benefit by extending the maintenance dose from 24 to 48 hours, if start of treatment must be delayed to between three and eight hours after injury.  [Download PDF]  [Resumen en español]

Gangliosides for acute spinal cord injury

The evidence available does not support the use of ganglioside treatment to reduce the death rate in spinal cord injury patients. No evidence has yet emerged that ganglioside treatment improves recovery or quality of life in survivors. [Download PDF]  [Resumen en español]

Mannitol for acute traumatic brain injury

Mannitol therapy for raised intracranial pressure (ICP) may have a beneficial effect on mortality when compared to pentobarbital treatment, but may have a detrimental effect on mortality when compared to hypertonic saline. ICP-directed treatment shows a small beneficial effect compared to treatment directed by neurological signs and physiological indicators. [Download PDF]  [Resumen en español]

Hypothermia for traumatic head injury

There is no evidence that hypothermia is beneficial in the treatment of head injury. Hypothermia should not be used except in the context of a high quality randomised controlled trial with good allocation concealment. [Download PDF]  [Resumen en español]

Corticosteroids for acute traumatic brain injury

The increase in mortality with steroids in this trial suggest that steroids should no longer be routinely used in people with traumatic head injury. [Download PDF]  [Resumen en español]

Psychological treatment for anxiety in people with traumatic brain injury

This review provides some evidence for the effectiveness of cognitive behavioural therapy (CBT) for treatment of acute stress disorder following mild traumatic brain injury (TBI) and CBT combined with neurorehabilitation for targeting general anxiety symptomatology in people with mild to moderate TBI. [Download PDF]  [Resumen en español]

Emergency interventions for hyperkalaemia

Nebulised or inhaled salbutamol, or IV insulin-and-glucose are the first-line therapies for the management of emergency hyperkalaemia that are best supported by the evidence. Their combination may be more effective than either alone, and should be considered when hyperkalaemia is severe. When arrhythmias are present, a wealth of anecdotal and animal data suggests that IV calcium is effective in treating arrhythmia. [Download PDF]  [Resumen en español]