Journal Club

How should teams approach apparently devastating brain injury when early prognosis is uncertain? This 2018 article and podcast explore guidance on initial care, conversations with families and the risk of premature treatment limitation. They also consider the practical tensions around specialist transfer, intensive-care capacity and organ donation.

Is paracetamol alone enough for pain after minor musculoskeletal injury? This 2017 review examines a randomised non-inferiority trial comparing paracetamol, diclofenac and their combination. It explores pain outcomes, trial design and exclusions, including why the findings cannot simply be extended to fractures or all painful injuries.

Can the Ottawa subarachnoid haemorrhage rule reduce unnecessary investigation without missing serious disease? This 2017 appraisal examines its prospective validation, patient selection and the tradeoff between sensitivity and specificity. Natalie May considers testing burden, clinician interpretation and why careful documentation of headache onset matters.

How much does delay matter when giving tranexamic acid? This 2017 journal club examines individual patient data from CRASH-2 and WOMAN, exploring the relationship between treatment timing and bleeding deaths, the size of the benefit and the analysis’s limitations.

Could cardiac myosin binding protein C offer an alternative to troponin? This 2017 review examines promising diagnostic findings from APACE, while explaining why external validation, a practical assay and evidence of added clinical value were still needed.

Does routine oxygen improve outcomes in suspected acute coronary syndromes? This 2017 appraisal of DETO2X-SWEDEHEART examines its patient selection, unexpectedly low event rate and mortality findings, explaining why a non-significant result does not establish that two treatments are equivalent.