RT Book, Section
A1 Sun, Xin
A1 Ioannidis, John P. A.
A1 Agoritsas, Thomas
A1 Alba, Ana C.
A1 Guyatt, Gordon
A2 Guyatt, Gordon
A2 Rennie, Drummond
A2 Meade, Maureen O.
A2 Cook, Deborah J.
SR Print(0)
ID 1183878067
T1 How to Use a Subgroup Analysis
T2 Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-179071-0
LK jamaevidence.mhmedical.com/content.aspx?aid=1183878067
RD 2024/04/18
AB CLINICAL  SCENARIOYou  are  a  physician  working  at  a  regional  trauma  center.  Your  unit's  committee,  which  is  responsible  for  standardization  of  care,  is  considering  using  tranexamic  acid  to  treat  trauma  patients  who  arrive  3  hours  after  injury.  Almost  all  of  the  information  on  this  topic  is  derived  from  a  single  blinded  trial  that  randomized  trauma  patients  to  tranexamic  acid  or  placebo.1The  original  publication  reported  that  99%  of  the  enrolled  patients  were  followed  up  and  there  was  a  reduction  in  all-cause  mortality  (relative  risk  [RR],  0.91;  95%  confidence  interval  [CI],  0.85-0.97)  with  no  apparent  subgroup  effect.1  A  subsequent  publication2  focused  on  an  additional  analysis  that  addressed  death  from  bleeding  and  reported  a  powerful  subgroup  effect  with  a  large  benefit  for  patients  treated  within  3  hours  of  injury  and  possible  harm  if  treated  3  or  more  hours  after  injury.  The  committee's  mandate  is  to  decide  whether  tranexamic  acid  should  not  be  given  to  patients  3  hours  or  more  after  injury.  The  credibility  you  place  on  the  subgroup  analysis  will  determine  your  decision.