Evidence-Based Medicine

Which balance of plasma, platelets and red cells should be used in major traumatic haemorrhage? This 2015 appraisal of the PROPPR trial examines mortality, haemostasis and deaths from bleeding, considering study power and the practical challenges of interpreting the results for transfusion protocols.

Which patients with blunt chest trauma are most likely to develop complications? This 2015 journal club examines the derivation and validation of a prognostic score, considering outcome definitions, reliability of recorded risk factors and the further evidence needed before a model should guide admission or discharge.

Why did progesterone’s promise in experimental brain injury fail to translate into benefit in a large clinical trial? This 2014 journal club examines patient selection, randomisation, anticipated treatment effects and stopping for futility, using the study to explore the challenges of translating laboratory findings into patient care.

Could time spent in an emergency department offer an opportunity for sexually transmitted infection screening? This 2014 appraisal examines a trial of brief counselling and testing in young women, questioning its sample size, generalisability and whether measuring immediate uptake captures the wider value of screening.

A 2014 appraisal of MR CLEAN, an early positive trial of intra-arterial treatment for selected patients with acute ischaemic stroke. Simon Carley examines imaging-based selection, pragmatic treatment choices and functional outcomes, while asking how confidently one trial could support wider adoption at the time.

This 2014 journal club examines the PARAMEDIC trial of mechanical versus manual CPR in out-of-hospital cardiac arrest. Alongside the cluster-randomised design and survival findings, Simon Carley reflects on separating life support from treatment of the underlying cause and how resuscitation teams divide their attention.