A simple, fast, easy method to identify the evidence base in pain-relief research: validation of a computer search strategy used alone to identify quality randomized controlled trials.

UNLABELLED: Clinicians need a simple, fast, reliable, and inexpensive way of identifying the evidence base relevant to their clinical practice. It is often believed that the only way to identify all relevant evidence is to perform hand-searches of the literature to supplement computer searches; this is complex and labor intensive. However, most of quality randomized controlled trials cited in systematic reviews in pain medicine are listed in computer databases. We performed two studies to investigate the efficiency-in terms of sensitivity, specificity, and precision-of three computer search strategies: Optimally Sensitive Search Strategy, which is used by the Cochrane Collaboration; RCT.pt, a standard MEDLINE strategy; and DBRCT.af, which is a new single-line computer algorithm based on the assumption that double-blinded, randomized controlled trials would be indexed with "double-blind," "random," or variations of these terms in MEDLINE and EMBASE. DBRCT.af was found to be highly sensitive (97%) in identifying quality randomized controlled trials in pain medicine. The precision (ratio of randomized controlled trials to the number of nonrandomized trials identified) was 82%, and the specificity in excluding the nonrandomized controlled trials was 98%. We conclude that clinicians can now use DBRCT.af to update and conduct de novo systematic reviews in pain-relief research. IMPLICATIONS: Quality evidence about what is good clinical practice in pain treatment is buried in the medical literature among large quantities of other information. This article describes how any clinician with access to the Internet can identify those quality studies reliably, quickly, and inexpensively.

Gender differences in acute mountain bike racing injuries.

OBJECTIVE: To evaluate injury rates and patterns in off-road bicycle racing, and to compare the findings in male and female cyclists. SETTING: The study was conducted from 1994-2001 at a large off-road bicycling competition held for 4 days each summer at Mammoth Mountain, California. DESIGN: Injured cyclists were evaluated at the first aid station or at the local hospital. Registration data were used to estimate the number of male and female competitors in each race. PARTICIPANTS: Cyclists who sustained an injury during a race and were unable to finish the race due to the injury were included in the study. 22 female subjects and 71 male subjects met the inclusion criteria during the 8-year study period. There were a total of 20,769 race participants during the study period. MAIN OUTCOME MEASURES: Injuries were categorized, and injury rates were calculated. RESULTS: The overall injury rate during the study period was 0.77% (22/2,869) for women versus 0.40% (71/17,900) for men (p = 0.01). Fractures were sustained by 45.5% (10/22) of female subjects versus 21.1% (15/71) of male subjects (p = 0.03). Odds ratios indicate that overall, women were 1.94 times more likely than men to sustain an injury and 4.17 times more likely to sustain a fracture. CONCLUSIONS: These data suggest that although participation in this sport is higher among men, the risk of injury is greater for women.

Mechanisms of injury in competitive off-road bicycling.

OBJECTIVE: To describe the mechanisms of injury from crashes during competitive off-road bicycling (mountain biking) and to examine the type, location, and severity of the resulting injuries. METHODS: We examined and interviewed all bicyclists injured while competing at 7 off-road bicycling events. Information regarding the direction of fall and the presence of a collision or mechanical failure was obtained, and the injury patterns were compared. RESULTS: There were 97 injured riders, with a mean age of 28.3 years. Most victims were male (74%), and all cyclists wore helmets. Most injuries were minor and involved the extremities (70.5%). Injuries sustained from falling forward over the handlebars occurred more often than from falling to the side (65% vs 25%), tended to lead to injuries that were more severe (mean injury severity score [ISS] = 3.4 vs 1.7, P < .05), and produced more head and neck injuries (56% vs 8%, P < .05). Falls to the side generally led to a lower extremity injury (88% vs 57%, P < .05). Riders who were involved in collisions had injuries that were similar in severity and location to those of riders who had no collision. CONCLUSIONS: These findings suggest that off-road bicyclists whose mechanism of injury involves falling forward over the handlebars are at risk for more severe injury, especially to the head and neck.