EMB COMMENTARY
Glue may be better than stitches, staples or adhesive tape for simple cuts
| Clinical Question | What is the best way to repair traumatic skin lacerations in children and adults? |
| Bottom Line | Pain scores and procedure time significantly favoured tissue adhesives over standard wound care (stitches, staples or adhesive tape). There was no significant difference in cosmetic appearance between tissue adhesive and standard wound care on either a Cosmetic Visual Analogue Scale or Wound Evaluation Score. |
| Caveat | There were small but statistically significant risk differences for dehiscence (favouring standard wound care, NNH 25*) and erythema (favouring tissue adhesives, NNH10). Although there are a few different types of glue available (based on butlycyanoacrylate and octylcyanoacrylate), no one glue seems to be superior. *NNH = number needed to treat to cause harm in one individual. |
| Context | Lacerations need to be closed to ensure proper healing and to prevent infection or unattractive scarring. This is the first systematic review comparing glue with standard wound closure. |
| Cochrane Systematic Review | Farion K, Osmond MH, Hartling L, Russell K, Klassen T, Crumley E, Wiebe N. Tissue adhesives for traumatic lacerations in children and adults. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003326. DOI: 10.1002/14651858.CD003326. This review contains 10 studies involving 522 participants. |
| PEARLS No. 11, August 2007, written by Brian R McAvoy | |
Local corticosteroid injections improve symptoms of carpal tunnel syndrome
| Clinical Question | How effective are local corticosteroid injections for carpal tunnel syndrome (CTS)? |
| Bottom Line | Local corticosteroid injections for CTS provide greater clinical improvement in symptoms one month after injection compared to placebo (NNT* 2). They also provide significantly greater clinical improvement compared to oral corticosteroids up to three months after treatment. Two injections do not provide significant further clinical improvement of symptoms. *NNT = number needed to treat to benefit one individual. |
| Caveat | Significant symptom relief beyond one month has not been demonstrated. |
| Context | CTS is a common problem with a prevalence of 3.8% in the general population. Up to 1/3 of patients can have spontaneous improvement in their symptoms without any formal medical treatment. |
| Cochrane Systematic Review | Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD001554. DOI: 10.1002/14651858.CD001554.pub2. This review contains 12 trials with 671 participants. |
| PEARLS No. 21. September 2007, written by Brian R McAvoy | |
Ultrasound screening for abdominal aortic aneurysm may reduce mortality in men aged 65 to 79 years
| Clinical Question | How effective is ultrasound screening for abdominal aortic aneurysm (AAA)? |
| Bottom Line | Ultrasound screening, followed by appropriate management, significantly reduced deaths from AAA in men aged 65 to 79 years (NNS *322 to 1312). There was insufficient evidence to demonstrate benefit in women. The cost-effectiveness of a coordinated population-based screening programme may be acceptable but this needs further expert analysis. *NNS = number needed to screen to prevent a death from AAA |
| Caveat | The incidence of AAA in women is lower than for men. All-case mortality was not significantly different between screened and unscreened groups three to five years after screening, which is to be expected given the relative infrequency of AAA as a cause of death. The “high NNS” is similar to other screening procedures. |
| Context | AAA is found in 5-10% of men aged 65 to 79 years. The major complication is rupture, which has a mortality of 80% for patients reaching hospital, and 50% for those undergoing surgery for emergency repair. Currently elective surgical repair is recommended for aneurysms discovered to be larger than 5.5 cm to prevent rupture. |
| Cochrane Systematic Review | Cosford PA, Leng GC. Screening for abdominal aortic aneurysm. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD002945. DOI: |
| PEARLS No. 26. October 2007, written by Brian R McAvoy | |
Pages: 12