Trauma & Orthopaedics

Can an observational study overturn the findings of a large randomised trial? This 2014 journal club examines a report questioning tranexamic acid in severe trauma, focusing on treatment selection, excluded early deaths and confounding as reasons to question a striking apparent association with harm.

Does improving an acid–base measurement demonstrate that a resuscitation fluid is better for patients? This 2014 journal club examines a small trial comparing Plasma-Lyte with saline in major trauma, exploring surrogate outcomes, fluid volumes and why the findings could not establish a benefit in patient-centred outcomes.

How common is pituitary dysfunction after serious head injury, and what should clinicians do about it? This 2014 journal club reviews a meta-analysis of patients requiring critical care, distinguishing evidence of endocrine abnormalities from unanswered questions about screening, treatment and outcomes.

PECARN, CHALICE or CATCH: how should we compare decision rules for children with head injuries? This 2014 journal club examines a prospective comparison, weighing sensitivity against specificity and exploring how sample size, confidence intervals and the handling of observation affect the apparent winner.

A contemporary review of NICE’s January 2014 head-injury guideline, CG176. The post explores what changed for emergency clinicians, including CT decisions in adults and children, anticoagulation, cervical spine imaging and discharge information, while discussing the evidence and uncertainties behind the recommendations.

Should a displaced ankle fracture be X-rayed before reduction? This 2013 journal club challenges the conclusions of a retrospective study, exploring differences between patient groups, missing documentation and the limitations of repeat manipulation as an outcome before accepting a proposed change in practice.