Does tranexamic acid improve recovery after spontaneous intracerebral haemorrhage? This 2018 appraisal of TICH-2 examines death and dependence, haematoma expansion and the uncertainty around the results. It explores why a possible effect on bleeding does not necessarily establish a meaningful improvement in patients’ longer-term outcomes.
JC: TICH TICH BOOM? TXA in ICH. St Emlyn’s Read More
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.
JC: Subarachnoid Haemorrhage, Decision Rules & Overtesting Headaches Read More
When might an early CT scan change the need for lumbar puncture in suspected subarachnoid haemorrhage? This 2016 discussion reviews the evidence available then, scanner and reporting requirements, and conversations with patients about uncertainty, further investigation and the risks of testing.
Let’s talk about subarachnoid haemorrhage Read More
A 2014 learning guide to headache in the emergency department, with a podcast, self-test and further resources. It explores concerning features in the history, neurological examination and decisions about investigations, emphasising discussion with senior colleagues when serious causes remain a concern.
Headache in the Emergency Department Read More
How strong was the evidence behind major transfusion protocols in trauma? This 2013 journal club examines a systematic review and meta-analysis, exploring before-and-after study bias, variation between protocols and why a statistically inconclusive pooled result may leave an important clinical question unresolved.
JC: Major Transfusion Protocols – evidence or lack of? St.Emlyn’s Read More
Could propofol have a role in refractory migraine? This 2013 journal club critiques an eight-patient case series, examining unclear recruitment, pain measurement during sedation and why larger, better-designed studies would be needed before drawing conclusions for practice.
JC: Milk for refractory migraines? Read More
This response to the 2012 NICE headache guidance considers its relevance to young people and adults presenting to emergency care. The discussion covers diagnostic features, imaging for reassurance, medication-overuse headache and the practical challenges of explaining assessment and treatment choices to patients.
