Tranexamic acid is safe to use following mild-to-moderate traumatic brain injury and reduces deaths
In people with mild-to-moderate traumatic brain injury, tranexamic acid (a drug which reduces bleeding) given within three hours of injury reduces the risk of death by 22%. This effect is seen in a subgroup of those who are less severely affected.
This NIHR-funded multi-centre international trial randomised 12,737 adults with intracranial bleeding to receive either tranexamic acid or a placebo. Overall, there was no difference in risk of death within 28 days between the two groups. However, whe...
Closer links between police and health services can improve experiences for people in mental health crisis
Tighter working partnerships between health professionals and police services are likely to improve the care of people who come into contact with police during mental health crises.
People experiencing severe mental health episodes can present with extreme and unpredictable behaviour posing a danger to themselves and members of the public. Police are often the first to respond in these challenging situations.
New models are emerging of mental health staff working with police. This NIHR-funded ...
Levetiracetam is a useful alternative to phenytoin in stopping prolonged epileptic seizures in children
Levetiracetam is as effective as phenytoin at stopping prolonged epileptic seizures in children. In this trial, levetiracetam stopped 70% of children convulsing compared with 64% for phenytoin within 35 to 45 minutes. Adverse events were similar. This combined with the fact levetiracetam may be easier to administer safely make it an important option.
Most epileptic seizures stop by themselves within a few minutes, but sometimes they continue for much longer. If this happens emergency treatment ...
National quality improvement programmes need time and resources to have an impact
A large trial assessing the effectiveness of a UK-wide quality improvement programme did not show any difference in patient outcomes. However, the likely reasons for this were carefully investigated and provide some useful insights on implementation.
Several (37) quality improvement components were included in the ambitious package designed to reduce variation in care and improve outcomes for adults undergoing emergency abdominal surgery. There was no difference in survival at 30 days, length o...
Providing pressurised air through a mask may improve outcomes for people with deteriorating heart failure
Non-invasive positive pressure ventilation may help people with rapidly deteriorating heart failure who become short of breath due to fluid build-up in the lungs. For people not requiring immediate mechanical ventilation using an endotracheal tube, this approach may reduce the risk of death in hospital and the need for intubation.
This review evaluated 24 trials of 2,664 adults comparing a group who received air under pressure through a mask, to a group receiving standard medical care. These ty...
Centralising stroke services can save lives
Changing access to more specialised stroke centre care in one city (London) was estimated to save an additional 96 lives per year (1%) compared to the reductions occurring in the rest of England. These improvements were sustained over time. Other cities did well on quality of care indicators, including time to admission in a stroke unit and length of stay. Patients and carers reported good experiences despite slightly increased travel times to the central stroke units.
A stroke can have devasta...
Are track and trigger systems linked to rates of in-hospital cardiac arrest?
Use of the National Early Warning Score (NEWS) to monitor adults in hospital is associated with reduced risk of having a cardiac arrest while in hospital. Using an electronic rather than paper-based system is also linked to reduced risk.
Many patients who die from a cardiac arrest while in hospital show signs of deterioration beforehand that aren’t identified or acted upon. Several interventions aimed at reducing these avoidable deaths have been introduced in the NHS. These includeNEWS, a...
An ultrasound scan is not as useful as a CT scan in assessing trauma
Ultrasound scans can be a useful tool to help pinpoint internal bleeding or organ damage in the chest or abdomen, but a negative scan cannot rule out damage, especially in children.
Many emergency departments use portable ultrasound scanners to assess for internal damage when someone has been subject to blunt trauma (for example, involved in a car accident or fallen from a height). Ultrasound is free from radiation, non-invasive and can be used at the bedside, making it convenient if CT is not ...
A new tool helps predict recovery from ankle sprain
The SPRAINED model may improve prediction of people who are at risk of delayed recovery from ankle sprain. This model was developed in the UK using clinical information from 584 adults with ankle injuries.
The model was validated using observational data from 682 people with ankle sprains across 10 different UK emergency departments. Delayed recovery from ankle injury was more likely to be detected when using the SPRAINED model than by clinicians using judgment alone.
Re-assessing pain levels ...
Early cooling provides no benefit following traumatic brain injury
Deliberate cooling (prophylactic hypothermia) in the early management of traumatic brain injury does not improve neurological outcomes at six months. Inducing hypothermia may also increase the risk of pneumonia.
Hypothermia (33-35oC) is sometimes induced to try and limit brain damage in people with severe head injuries. However, evidence for its safety and effectiveness has been mixed. A 2015 trial (Eurotherm 3235) found that therapeutic hypothermia, for adults with raised intracranial pressur...