Cochrane Evidence Aid: resources for Chile and Haiti earthquakes

Glucose-based rehydration solution (ORS) for treating dehydration caused by acute diarrhoea in children

In children admitted to hospital with diarrhoea, reduced osmolarity ORS [oral rehydration solution] [total osmolarity ≤ 250 mmol/L with reduced sodium] when compared to WHO [World Health Organization] standard ORS [90 mmol/L sodium, 111mmol/L glucose, total osmolarity 311 mmol/L] is associated with fewer unscheduled intravenous fluid infusions, lower stool volume post randomization, and less vomiting. No additional risk of developing hyponatraemia when compared with WHO standard ORS was detected. Note: Since the publication of this review, the WHO standard has changed to a reduced osmolarity ORS.  [Download PDF]  [Resumen en español]  [Evidence Update summary   (en español)]

Polymer-based oral rehydration solution for treating acute watery diarrhoea

Polymer-based ORS [oral rehydration solution] shows some advantages compared to ORS ≥ 310 [the original ORS was based on glucose and had an osmolarity of ≥ 310 mOsm/L] for treating all-cause diarrhoea, and in diarrhoea caused by cholera. Comparisons favoured the polymer-based ORS over ORS ≤ 270 [the currently agreed best formula with ≤ 270 mOsm/L], but the analysis was underpowered. [Download PDF]  [Resumen en español]  [Evidence Update summary]

Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children

There were no important clinical differences between ORT and IVT for rehydration secondary to acute gastroenteritis in children. It seems reasonable that children presenting for medical care with mild to moderate dehydration secondary to acute gastroenteritis should initially be treated with ORT. Should treatment fail, then IVT may be used. In children who have persistent vomiting, ORT may be used, but the child must be closely observed for proof of successful treatment.

For every 25 children treated with ORT, one would fail and require IVT. Clinicians and families need to apply this evidence to individual situations in order to decide whether they are willing to accept this minimal risk. [Download PDF]  [Resumen en español]  [Evidence Update summary]

Oral zinc for treating diarrhoea in children

In areas where diarrhoea is an important cause of child mortality, research evidence shows zinc is clearly of benefit in children aged six months or more. [Download PDF]  [Resumen en español]

Probiotics for treating infectious diarrhoea

Probiotics appear to be a useful adjunct to rehydration therapy in treating acute, infectious diarrhoea in adults and children. [Download PDF]  [Resumen en español]   [Evidence Update summary   (en español)]

Antibiotic therapy for Shigella dysentery

We recommend the use of antibiotics for moderate to severe Shigella dysentery. The choice of antibiotic to use as first line against Shigella dysentery should be governed by periodically updated local antibiotic sensitivity patterns of Shigella isolates. Other supportive and preventive measures recommended by the WHO [World Health Organization – see review for references] should also be instituted along with antibiotics (eg health education and handwashing).  [Download PDF]  [Resumen en español]

Azithromycin for treating uncomplicated typhoid and paratyphoid fever (enteric fever)

Azithromycin appears better than fluoroquinolone drugs in populations that included participants with drug-resistant strains. Azithromycin may perform better than ceftriaxone.  [Download PDF]  [Resumen en español]

Tissue adhesives for traumatic lacerations in children and adults

Tissue adhesives are an acceptable alternative to standard wound closure for repairing simple traumatic lacerations. They offer the benefit of decreased procedure time and less pain, when compared to standard wound closure. A small but statistically significant increased rate of dehiscence with tissue adhesives is observed. [Download PDF]  [Resumen en español]  [Evidence Update summary   (en español)]

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)]

Anaesthesia for treating distal radial fracture in adults

There is some indication that haematoma block provides poorer analgesia than intravenous regional anaesthesia, and can compromise reduction. [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]

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]

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]

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]

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]

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]

Pre-operative traction for fractures of the proximal femur 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. [Download PDF]  [Resumen en español]

Rehabilitation for ankle fractures in adults

There is limited evidence supporting the use of a removable type of immobilisation and exercise during the immobilisation period, early commencement of weight-bearing during the immobilisation period, and no immobilisation after surgical fixation of ankle fracture. There is also limited evidence for manual therapy after the immobilisation period. Because of the potential increased risk, the patient's ability to comply with the use of a removable type of immobilisation and exercise is essential. [Download PDF]  [Resumen en español]

Antibiotics for preventing infection in open limb fractures

Antibiotics reduce the incidence of early infections in open fractures of the limbs. [Download PDF]  [Resumen 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]

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]

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]

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]

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]

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]

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]

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]

Intermittent versus continuous renal replacement therapy for acute renal failure in adults

In patients who are haemodynamically stable, the renal replacement therapy (RRT) modality does not appear to influence important patient outcomes, and therefore the preference for continuous RRT (CRRT) over intermittent RRT (IRRT) in such patients does not appear justified in the light of available evidence. CRRT was shown to achieve better haemodynamic parameters such as mean arterial pressure. Future research should focus on factors such as the dose of dialysis and evaluation of newer promising hybrid technologies such as sustained low-efficiency dialysis (SLED). Triallists should follow the recommendations regarding clinical endpoints assessment in randomised trials in acute renal failure made by the Working Group of the Acute Dialysis Quality Initiative Working Group. [Download PDF]  [Resumen en español]

Preoperative blood transfusions for sickle cell disease

While in general, conservative therapy appears to be as effective as aggressive therapy in preparation for surgery in people with sickle cell disease, further research is needed to examine the optimal regimen for different surgical types, and to address whether preoperative transfusion is needed in all surgical situations. [Download PDF]   [Resumen en español]

Drugs for preventing red blood cell dehydration in people with sickle cell disease

While the results of zinc for reducing sickle-related crises are encouraging, larger and longer-term multicentre studies are needed to evaluate the effectiveness of this therapy for people with sickle cell disease.

Though the phase II study of senicapoc showed that the drug improved red cell survival, depending on dose, this did not lead to fewer painful crises; a subsequent phase III study was terminated prematurely for this reason. [Download PDF]

Hydroxyurea for sickle cell disease

In patients who are haemodynamically stable, the renal replacement therapy (RRT) modality does not appear to influence important patient outcomes, and therefore the preference for continuous RRT (CRRT) over intermittent RRT (IRRT) in such patients does not appear justified in the light of available evidence. CRRT was shown to achieve better haemodynamic parameters such as mean arterial pressure. Future research should focus on factors such as the dose of dialysis and evaluation of newer promising hybrid technologies such as sustained low-efficiency dialysis (SLED). Triallists should follow the recommendations regarding clinical endpoints assessment in randomised trials in acute renal failure made by the Working Group of the Acute Dialysis Quality Initiative Working Group. [Download PDF]  [Resumen en español]