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It's NICE to dream of a better neurosurgical service
The NICE guidelines on the management of head injury are challenged this month by Barrett et al who have conducted their own systematic review on the benefits of transferring an increased number of patients to neurosurgical centres. Their review highlights the unmet need of head-injured patients but also seriously questions the evidence base on which the NICE guidelines are based. This issue will have major implications for emergency departments that are not co-located with a regional neurosurgical unit. How ‘evidence based’ are the NICE guidelines? Barrett et al raise some serious concerns (see page 173).
A rapid Troponin is better for patients and the hospital
It's good to see a diagnostic test that seems to be of obvious benefit (near patient testing of Troponin levels) subjected to a formal evaluation. As Loten et al explain, there are often barriers to the adoption and utility of near-patient tests and their decision to formally test this in a randomised controlled trial is to be commended. I won't spoil …
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