It's April First!

A couple of years ago, the British Medical Journal published what I thought was a provocative clinical trial, "Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial".  Individuals 18 years or older who were planning on jumping out of a perfectly good airplane were eligible to participate in the study.  Subjects were randomized to one of two groups - parachute (the experimental condition) and no parachute (the control).  Ninety-two individuals were approached, though only nineteen agreed to participate.  The outcome of interest was death or major trauma (defined by an Injury Severity Score greater than 15).  

Surprisingly, there were no significant differences in death or major injury between the two groups (0% for parachute v 0% for control; P>0.9). This finding was consistent across multiple subgroups. Compared with individuals screened but not enrolled, participants included in the study were on aircraft at significantly lower altitude (mean of 0.6 m for participants versus mean of 9146 m for non-participants; P<0.001) and lower velocity (mean of 0 km/h v mean of 800 km/h; P<0.001).  The study investigators concluded that parachute use did not reduce death or major trauma, though they recognized the limitations in their study design and suggested that the findings of their study may not be translated to the general population of skydiving enthusiasts.

Bravo to the editorial staff of the British Medical Journal for publishing such an important study, even though the results of this clinical trial were negative!  As you may have figured out by the title of the blog post, the study was a little farcical (although I do think they actually conducted the study). I do believe the authors were poking fun at the concept of evidence-based medicine suggesting that you don't always need clinical trial evidence for certain clinical interventions.  For example, one of my former attending physicians used to argue that there are no clinical trials suggesting that we should or should not monitor patients' blood pressure in the intensive care unit right before challenging us to think about managing a patient without measuring trends in important vital signs.  I won't jump into the pro/con debate on the merits of evidence-based medicine.  For now, I will just wish everyone a happy April Fool's Day!