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Centre for Evidence-
Based Medicine

Harm: Clinical Scenario

You are asked to see a 73 year old patient on ITU who is being treated for a head injury after a road traffic accident. She has osteoarthritis and was taking a regular dose of a non-steroidal anti-inflammatory prior to hospitalization. She has had a small haematemesis and, on oesophago-gastro duodenoscopy you diagnose NSAID erosions. She has a negative CLO test for helicobacter pylori. You suggest treatment with ranitidine. Your ITU colleague recommends sucralfate as an alternative and sites evidence of lower rates of infection with sucralfate. You appraise the literature together.

You formulate the question "In patients on ITU is rantidine or sucralfate associated with a lower rate of infections?" You track down the Annals of Surgery article that she has referred to. Annals of Surgery 1998;227:120-125.

Read the article and decide:

  1. Are the results of this harm study valid?
  2. Are the results of this harm study important?
  3. Should these valid, important results of this study about a potentially harmful treatment change the treatment of your patient?

Continue to completed worksheet