Website of interest: BestBETs

BestBETs have been around for at least ten years and is produced by the Emergency Department of Manchester Royal Infirmary, UK.  The website states that it’s aim is:

…to provide rapid evidence-based answers to real-life clinical questions, using a systematic approach to reviewing the literature.

The methodology has been static over the years and each answer/review follows the same structure.  Using the recent review (Fluid resuscitation in penetrating chest injury) to illustrate the flow:

  • Author details, date of review and date of checking
  • Three part question based on PICO e.g. In [adult patients presenting to the Emergency Department with penetrating chest injury] does [restrictive fluid resuscitation] affect [mortality]?
  • Clinical scenario
  • Search strategy, in this case Medline, Embase and Cochrane
  • Search outcomes: They found 143 papers were identified in PubMed, of which 3 were retained after abstract review. The other sources supplied no additional references
  • Data table. Relevant data from each article is placed into a table with columns such as study type, outcomes, key results and study weaknesses
  • Comments
  • Editors comments
  • Clinical bottom line, in this case “There is limited available evidence pertaining directly to the use of fluids in penetrating thoracic injury. In comparison to delayed or limited fluid resuscitation, early aggressive fluid resuscitation of adults with penetrating torso trauma appears to be detrimental to patient outcome. There is however no evidence as to whether small aliquots of fluid titrated to clinical response or withholding all fluid resuscitation until operative management is preferable. Pending further research, expert consensus guidelines should be followed with judicious use of fluids.
  • References

In addition to individual reviews the site also includes a number of other useful bits of background such as search strategies and critical appraisal worksheets.


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