Difference between revisions of "Bennett3"
(Imported from Wikispaces) |
|||
| Line 1: | Line 1: | ||
| − | <span style="color: #003366; font-family: Arial,Helvetica,sans-serif; font-size: 130%;">'''Tenoxicam reduced the number of compressions required to treat DCI''' </span> | + | |
| − | {| | + | <span style="color: #003366; font-family: Arial,Helvetica,sans-serif; font-size: 130%;">'''Tenoxicam reduced the number of compressions required to treat DCI'''</span> |
| − | + | ||
| + | {| | ||
|- | |- | ||
| + | | '''<span>Clinical Bottom Line:</span>'''<br/> <span>1. Oral tenocixam reduced the number of compressions required for treatment of DCI in recreational divers, but had no impact on overall outcome.</span> | ||
|} | |} | ||
| − | |||
| − | |||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Three-part Clinical Question:''' In recreational divers with DCI, would addition of oral tenoxicam to standard compression therapy improve outcome and/or reduce number of compressions required?</span> | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Citation:'''1. Bennett M, Mitchell S, Dominguez A. Adjunctive treatment of decompression illness with a non-steroidal anti-inflammatory drug (Tenoxicam) reduces compression requirements. Undersea and Hyperbaric Medicine 2003; 30(3):195-204.</span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Lead author's name and fax:''' M. Bennett [[mailto:m.bennett@unsw.edu.au| m.bennett@unsw.edu.au]]</span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Search Terms:''' Decompression illness, non-steroidal anti-inflammatory drug, tenoxicam</span> | + | |
| + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Three-part Clinical Question:''' In recreational divers with DCI, would addition of oral tenoxicam to standard compression therapy improve outcome and/or reduce number of compressions required?</span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Search Terms:''' Decompression illness, non-steroidal anti-inflammatory drug, tenoxicam</span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study:'''Double-blinded concealed randomised controlled trial with intention-to-treat.</span> | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study:'''Double-blinded concealed randomised controlled trial with intention-to-treat.</span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study Patients:''' Adult divers presenting for treatment of DCI and where the clinical diagnosis was not cerebral arterial gas embolism (CAGE).</span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Control group''' (N = 90; 80 analysed): Initial compression schedule by physician choice, including USN TT6, USN TT5 and 2.4ATA 90 min O2 table. Follow-up treatments either 2.4 ATA 90 minute O2 table or 1.9 ATA 120 minute O2 table until cure or plateau. Placebo given at initial treatment during first air break and for total of 7 daily doses.</span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Experimental group''' (N = 90; 84 analysed): As above but tenoxicam given at initial treatment during first air break and for total of 7 daily doses.</span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study Patients:''' Adult divers presenting for treatment of DCI and where the clinical diagnosis was not cerebral arterial gas embolism (CAGE).</span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Control group''' (N = 90; 80 analysed): Initial compression schedule by physician choice, including USN TT6, USN TT5 and 2.4ATA 90 min O2 table. Follow-up treatments either 2.4 ATA 90 minute O2 table or 1.9 ATA 120 minute O2 table until cure or plateau. Placebo given at initial treatment during first air break and for total of 7 daily doses.</span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Experimental group''' (N = 90; 84 analysed): As above but tenoxicam given at initial treatment during first air break and for total of 7 daily doses.</span> | ||
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Evidence:'''</span> | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Evidence:'''</span> | ||
| − | {| | + | {| |
| − | |||
|- | |- | ||
| − | | <span | + | | <span><span>'''Outcome'''</span></span> |
| + | | <span><span>'''Time to Outcome'''</span></span> | ||
| + | | <span><span>'''Control group'''</span></span> | ||
| + | | <span><span>'''Tenoxicam group'''</span></span> | ||
| + | | <span><span>'''Relative risk reduction'''</span></span> | ||
| + | | <span><span>'''Absolute risk reduction'''</span></span> | ||
| + | | <span><span>'''NNT'''</span></span> | ||
|- | |- | ||
| − | | | + | | <span><span>'''Proportion not completely well'''</span></span> |
| + | | <span><span>discharge</span></span> | ||
| + | | <span><span>0.28</span></span> | ||
| + | | <span><span>0.34</span></span> | ||
| + | | <span><span>-24%</span></span> | ||
| + | | <span><span>-0.07</span></span> | ||
| + | | <span><span>-15</span></span> | ||
|- | |- | ||
| − | | <span | + | | ^ |
| + | | | ||
| + | | | ||
| + | | <span><span>95% Confidence Intervals:</span></span> | ||
| + | | <span><span>-72% to 25%</span></span> | ||
| + | | <span><span>-0.20 to 0.07</span></span> | ||
| + | | <span><span>NNT '''15 to INF NNH ''' 5 to INF</span></span> | ||
|- | |- | ||
| − | | | + | | <span><span>'''Proportion not completely well'''</span></span> |
| + | | <span><span>4 to 6 weeks</span></span> | ||
| + | | <span><span>0.18</span></span> | ||
| + | | <span><span>0.16</span></span> | ||
| + | | <span><span>12%</span></span> | ||
| + | | <span><span>0.02</span></span> | ||
| + | | <span><span>45</span></span> | ||
|- | |- | ||
| + | | ^ | ||
| + | | | ||
| + | | | ||
| + | | <span><span>95% Confidence Intervals:</span></span> | ||
| + | | <span><span>-49% to 74%</span></span> | ||
| + | | <span><span>-0.09 to 0.13</span></span> | ||
| + | | <span><span>NNT '''8 to INF NNH ''' 12 to INF</span></span> | ||
|} | |} | ||
| − | {| | + | {| |
| − | |||
|- | |- | ||
| − | | <span | + | | <span><span>'''Non-Event Outcomes'''</span></span> |
| + | | <span><span>'''Time to outcome/s'''</span></span> | ||
| + | | <span><span>'''Control group'''</span></span> | ||
| + | | <span>'''Tenoxicam group'''</span> | ||
| + | | <span><span style="display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;">'''P-value'''</span></span> | ||
|- | |- | ||
| + | | <span>'''Median number of treatments required'''</span> | ||
| + | | <span>discharge</span> | ||
| + | | <span><span>3</span></span> | ||
| + | | <span><span>2</span></span> | ||
| + | | <span><span>0.01</span></span> | ||
|} | |} | ||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">''' | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Comments:'''</span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. Patient compliance depended on self-administration and self-reporting. Possible that this would underestimate the efficacy of tenoxicam, however, this reflects clinical practice.</span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2. At the time of discharge 9% of patients had an different diagnosis (musculoskeletal injury, respiratory tract infection, ear barotrauma and CAGE). ?possibility that results reflect efficacy of tenoxicam on non-DCI injury.</span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">3. Tenoxicam's treatment sparing effect occurred at all grades of severity.</span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">4. Can't exclude possibility that tenoxicam reduced pain and as a consequence reduced number of compressions were due to this effect. No evidence this affected outcome at six weeks.</span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">' | ||
| − | [[ | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Appraised by:''' S. Singham, Prince of Wales Hospital, Sydney; Thursday, 23 December 2004Email: [[mailto:s_singham@yahoo.com| s_singham@yahoo.com]]</span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Kill or Update By:''' December 2021</span> |
| − | <span style=" | ||
| − | <span style="font-size: | + | [[File:Sumhorsa.gif|center|Sumhorsa.gif]] <span style="display: block; text-align: center;"></span> |
| + | <p style="text-align: center;"><span style="font-size:xx-large;">[[Diving_Medicine|BACK]]</span></p> | ||
Latest revision as of 00:38, 4 January 2023
Tenoxicam reduced the number of compressions required to treat DCI
| Clinical Bottom Line: 1. Oral tenocixam reduced the number of compressions required for treatment of DCI in recreational divers, but had no impact on overall outcome. |
Citation:1. Bennett M, Mitchell S, Dominguez A. Adjunctive treatment of decompression illness with a non-steroidal anti-inflammatory drug (Tenoxicam) reduces compression requirements. Undersea and Hyperbaric Medicine 2003; 30(3):195-204. Lead author's name and fax: M. Bennett [m.bennett@unsw.edu.au]
Three-part Clinical Question: In recreational divers with DCI, would addition of oral tenoxicam to standard compression therapy improve outcome and/or reduce number of compressions required? Search Terms: Decompression illness, non-steroidal anti-inflammatory drug, tenoxicam
The Study:Double-blinded concealed randomised controlled trial with intention-to-treat. The Study Patients: Adult divers presenting for treatment of DCI and where the clinical diagnosis was not cerebral arterial gas embolism (CAGE). Control group (N = 90; 80 analysed): Initial compression schedule by physician choice, including USN TT6, USN TT5 and 2.4ATA 90 min O2 table. Follow-up treatments either 2.4 ATA 90 minute O2 table or 1.9 ATA 120 minute O2 table until cure or plateau. Placebo given at initial treatment during first air break and for total of 7 daily doses. Experimental group (N = 90; 84 analysed): As above but tenoxicam given at initial treatment during first air break and for total of 7 daily doses.
The Evidence:
| Outcome | Time to Outcome | Control group | Tenoxicam group | Relative risk reduction | Absolute risk reduction | NNT |
| Proportion not completely well | discharge | 0.28 | 0.34 | -24% | -0.07 | -15 |
| ^ | 95% Confidence Intervals: | -72% to 25% | -0.20 to 0.07 | NNT 15 to INF NNH 5 to INF | ||
| Proportion not completely well | 4 to 6 weeks | 0.18 | 0.16 | 12% | 0.02 | 45 |
| ^ | 95% Confidence Intervals: | -49% to 74% | -0.09 to 0.13 | NNT 8 to INF NNH 12 to INF |
| Non-Event Outcomes | Time to outcome/s | Control group | Tenoxicam group | P-value |
| Median number of treatments required | discharge | 3 | 2 | 0.01 |
Comments: 1. Patient compliance depended on self-administration and self-reporting. Possible that this would underestimate the efficacy of tenoxicam, however, this reflects clinical practice. 2. At the time of discharge 9% of patients had an different diagnosis (musculoskeletal injury, respiratory tract infection, ear barotrauma and CAGE). ?possibility that results reflect efficacy of tenoxicam on non-DCI injury. 3. Tenoxicam's treatment sparing effect occurred at all grades of severity. 4. Can't exclude possibility that tenoxicam reduced pain and as a consequence reduced number of compressions were due to this effect. No evidence this affected outcome at six weeks.
Appraised by: S. Singham, Prince of Wales Hospital, Sydney; Thursday, 23 December 2004Email: [s_singham@yahoo.com] Kill or Update By: December 2021
