Evidence-Based Medicine

Could intramuscular tranexamic acid be useful when intravenous delivery is difficult? This 2020 review examines a small pharmacokinetic study in trauma patients who had already received IV TXA, distinguishing encouraging absorption data from evidence of improved outcomes or effectiveness as an initial dose.

A September 2020 appraisal of the ISARIC 4C mortality score for hospitalised patients with COVID-19. It explains model development and internal validation, then examines methodological concerns, access to required tests and the limits of applying a UK inpatient score in other settings.

Does prehospital tranexamic acid improve neurological recovery after moderate or severe head injury? This September 2020 trial appraisal examines the absence of a clear primary-outcome benefit, missing follow-up data, injury severity and how the findings compare with CRASH-3.

An August 2020 appraisal of hydroxychloroquine after household or occupational exposure to COVID-19. It examines a placebo-controlled trial's lack of a clear benefit, adverse effects and the uncertainty introduced by remote recruitment and outcomes based largely on self-reported symptoms.

A 2020 appraisal of intravenous haloperidol for acute benign headache. The review considers pain relief, adverse effects and patient selection, asking whether a placebo-controlled trial can tell us enough when the useful clinical comparison would be with usual headache treatment.

A critical tour of trauma research from 2019–20, covering tranexamic acid in head injury, plasma and whole blood, hypocalcaemia and prehospital care. Simon Carley weighs trial findings against the limits of observational evidence, with an additional look at the Zero Point Survey.