Loewenberg School of Nursing
The purpose of this critical appraisal is to review a particular recent research article with appropriate implication to nursing practice of the article comparing two acute migraine treatment modalities intravenous prochlorperazine and diphenhydramine versus subcutaneous sumatriptan (Kostic, Gutierrez, Rieg, Moore, & Gendron, 2010).
Title and Abstract
The title “A prospective, randomized trial of intravenous prochlorperazine versus subcutaneous sumatriptan in acute migraine therapy in the emergency department” succinctly describes the research that is conducted. The abstract is very brief and includes the study purpose, sample size, design description, and conclusion. The abstract would have been strengthened by clearly stating the problem. The problem is distinguishing the most efficacious treatment of the two medications as evidenced by the patient’s adequate relief of pain, nausea, and/or sedation. Also, the abstract lacked a background section stating previous research conclusions regarding one or both of these medications treatment of migraines.
The gap of knowledge is expressed in the introduction background section. There is only one previous study, published in abstract form that reports prochlorperazine superior in treatment of migraines, but does not compare both drugs. This previous study lends to the reader a weak premise based upon the small sample size and lack of published full research. The limited previous study does lend to a problem that is significant to generate knowledge for practice. Migraines are among the top three reasons to visit the emergency department(ED) constituting 2.2% of all US ED visits (Kostic et al., 2010, p. 1). Studies of various medication treatments exist regarding effective migraine treatment, but not with a statistically significant sample to compare prochlorperazine and sumatriptan with a measure of improvement in pain.
Problem and Purpose
The purpose clearly states that the goal of the study is to prove that IV prochlorperazine with diphenhydramine is superior to subcutaneous sumatriptan in reducing or halting acute migraines among ED patients. The editor’s capsule summary accurately describes that both drugs are used to treat migraines but little evidence exists to support one over the other. This study addresses that prochlorperazine is superior to sumatriptan in pain relief with the same side effects of nausea and sedation (Kostic et al., 2010, p. 2). It is interjected in the background that diphenhydramine is often given with prochlorperazine to reduce akathisia (Kostic et al., 2010, p. 1). The variables, or the outcome measurement of the mean improvement in pain response as indicated by a 13mm or greater improvement on the visual analog scale (VAS) 80 minutes post treatment among 66 consecutive patients that have been identified with acute migraines in a double blind randomized clinical trial with placebo controls among a Department of Defense closed emergency department with phone call after discharge as follow up was identified in the purpose.
There are twenty five recent and current references with which the authors draw from a literary review. However, only one sentence is utilized precluding the hypothesis of the study that prochlorperazine is the most effective in acute migraine treatment. This statement refers to only one of the twenty five articles referenced in research as the limited knowledge about the comparison of the two particular medications is limited with this malady. A literature search did not reveal other studies not mentioned in this research article. Therefore, the studies that pertain to this particular research problem are thorough, provide a rational and context for the study, and are referenced by the author. (Burns & Grove, 2011, p. 440). Conceptual Framework