Evidence-Based Medicine

How well do guidelines identify meningococcal disease in children with fever and a non-blanching rash? Natalie May reviews the PiC study, examining sensitivity, overtreatment and what happened when clinicians departed from protocols, while keeping the study population and limitations in view.

Could early prehospital plasma help trauma patients with brain injury? This 2020 review examines a secondary analysis of PAMPer, its apparent survival signal and why post-hoc findings, uncertain mechanisms and unanswered neurological-outcome questions require caution before changing practice.

Could carotid ultrasound make pulse checks more reliable? Natalie May examines a proof-of-concept study using recordings from patients undergoing cardiac surgery, and explains why interpreting those images is a different challenge from obtaining and using them during a real cardiac arrest.

What does STAAMP add to the evidence for prehospital tranexamic acid after trauma? This 2020 appraisal examines the lack of a clear overall mortality benefit, recruitment and power limitations, safety findings and the caution needed when interpreting encouraging timing, shock and dosing subgroups.

An October 2020 appraisal of RECOVERY's hydroxychloroquine results in hospitalised patients with COVID-19. It reviews the lack of demonstrated benefit, concerns about harm and the arguments about timing and dosage, alongside an explanation of how the platform trial was organised.

Can antibiotics offer an alternative to surgery for selected adults with appendicitis? This 2020 trial appraisal weighs short-term health status against subsequent operations, recurrence and the limits of follow-up, explaining why the choice needs a more nuanced conversation than a simple yes or no.