Thread by @AndyDW_

Hiya. This Friday night I am going to use this example of sharing a paper via social media to make a more general comment on how we frame studies and query whether people read what they share.

https://twitter.com/bjajournals/status/1215205288673976320

So note the framing here that ‘this animal cadaver study leads to the ability to perform emergency child tracheotomy in < 1 min’.

(And I have two things to note:
- On my read this is a really well done study. Really rigorous. Described with great clarity. A great contribution.
- I am commenting in a personal capacity, but I also have some responsibility for framing stuff for other journals in social media.)

So for people outside this niche area of medicine (yeah, most of you) you need to be aware that there is a clinical situation where the person trying to get air on and out of the little person might struggle with that.

And this is a big issue because oxygen matters.

I should say this is incredibly rare. But we train for it because being ready is our job.

So if you need to get oxygen in to the kid and nothing else is working as a final shot you’d do a surgical thing of some sort to let you deliver oxygen straight to the windpipe.

You can’t do a randomised trial on this so the best technique is unclear.

Now, back to the tweet and the paper. The tweet suggests that people got better at front of neck access (the surgical thing) in kids. But that is not what the authors say and it’s not what they looked at.

The authors looked at improvement in time to successful lung inflation over 10 attempts using an animal cadaver model (a bit of a rabbit) fixed to a block.

So the authors comment on the fact that time to ‘doing the job’ on this animal model decreased over the attempt. The greatest improvement happened over the first 4 tries.

This is really useful! It suggests that when we are training, the physical ability to do the steps gets better over 4 practice attempts. I can use this!

This is relevant to the kids’ airway course we run. (This is the previously mentioned best kids’ airway course anywhere, anytime. But I digress.)

Even a few practice efforts are useful.

But even the non-medical out there would spot that this does not say ‘people get better at doing emergency airway procedures in kids’.

For starters, it hasn’t been tested in kids. And while some folks use the rabbit cadaver model for this practice, it’s not like we can say ‘this definitely correlated with actually doing it in a kid’. We are just all aware that it is a compromise. A decent option.

But we know from other work, particularly the National Audit Project (the 4th one), that undertaking such a procedure is not just about the technique.

Sorry, the link to NAP4 is here. nationalauditprojects.org.uk/NAP4_home

Anyway, even if we could be certain that a single technique is best (and we can’t be sure in small kids) we know that doing this is about more than that....

For starters you have to recognise that it is a true ‘I can’t give this kid oxygen’ scenario.

Then you have to say to yourself, ‘no really, I have to move on, not just keep trying the stuff that feels familiar’.

And then you have to really commit. And then choose the technique. And also communicate to everyone in the room. And then actually do it.

See how the study didn’t look at any of that?

So if you say ‘people got better at doing it in kids’ when the study and the authors say nothing of the sort, that’s not ok. At least in my opinion.

The thing is this is obvious just in the abstract. But I see people just sharing it without comment.

I can only conclude they didn’t pause for a second to think about it.

This seems ... not great.

Y’know how I know that no one is reading it? The authors separated out the performance of men at this task vs women on this task.

And I know that this would be likely to draw heaps of comment. I mean heaps.

They specifically talk about initial performance of men vs women, relative complication rates, rates of improvement ....

And no one who has retweeted seems to have commented.

This seems ... unlikely.

Which brings me to this: evidence-based medicine requires more of us than to uncritically share a thing because a journal put it out there.

It definitely requires us to actually read the paper.

Social media didn’t tell us to stop being doctors.

(That’s it. I am entirely open to people saying ‘yeah actually your take sucks’. This is also part of the deal.)

Anyway. At least 6 folks have shared the initial tweet I was responding to. One of them is the Difficuot Airway Society. Maybe I’m on my lonesome here.

This would have been a more effective tweet if it said ‘Difficult’ as intended, rather than ‘Difficuot’ which for some reason attracted zero interest from autocarrot. Honestly.