Table 3 The summary of findings table for PICO #2: Hydromorphone (i.v.) vs. morphine (i.v.) for acute severe pain in the emergency department
Anticipated absolute effects Time frame is 30 min | |||||
|---|---|---|---|---|---|
Outcomes | No of patients (studies) Follow-up | Quality of the evidence (GRADE) | Relative effect (95% Cl) | Rish with morphine | Rish difference with hydromorphone (95% Cl) |
Change in pain score Mean change in numeric rating scale (NRS) [0 = no pain; 10 = worst pain possible]; scale from 0-10 | 374 (2 studies) 2 h | ⊕⊕⊕O MODERATE2,3 due to indirectness | The mean change in pain score ranged across control groups from 3.3-4.1 NRS | The mean change in pain score in the intervention groups was 0.9 higher (0.35 to 1.75 higher)1 | |
Serious adverse events respiratory depression (RR < 12) or SpO2 < 95% or systolic blood pressure (SBP) < 90 mmHg or administration of naloxone after opioid administration | 374 (2 studies) 2 h | ⊕⊕OO LOW3,4 due to indirectness, imprecision | RR 0.96 (0.91-1.02) | 54 per 1,000 | 2 fewer per 1,000 (from 5 fewer to 1 more)4 |
Adverse effects Nausea or vomiting or pruritus | 374 (2 studies) 2 h | ⊕⊕OO LOW3,4 due to indirectness, imprecision | RR 0.96 (0.83-1.1) | 299 per 1,000 | 12 fewer per 1,000 (from 51 fewer to 30 more) |
The basis for the assumed risk (e. g., the median control group risk across studies) is provided in footnotes. The corresponding risk (and the 95% confidence interval [CI]) is based on the assumed risk in the comparison group and the relative effect of the intervention. RR: risk ratio | |||||
GRADE Working Groups grades of evidence | |||||
High quality: | Further research is very unlikely to change our confidence in the estimate of effect | ||||
Moderate quality: | Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate | ||||
Very low quality: | We are very uncertain about the estimate | ||||