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Journal update
Journal update monthly top five
  1. Liam Barrett1,2,
  2. Owen Hibberd2,3,
  3. Daniel P Whitehouse1,2,
  4. Thomas Adams1,2,
  5. James Price2,4,
  6. Sophie Richter1,2,
  7. Ed Benjamin Graham Barnard2,4,5,
  8. Anisa Jabeen Nasir Jafar6,7
  1. 1 University Division of Anaesthesia, Cambridge University, Cambridge, UK
  2. 2 Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  3. 3 Blizard Institute, Queen Mary University London, London, UK
  4. 4 Department of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Norwich, UK
  5. 5 Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  6. 6 Humanitarian and Conflict Response Institute (HCRI), Ellen Wilkinson Building, University of Manchester, Manchester, UK
  7. 7 Emergency Department, Salford Royal Foundation Trust, Salford Royal Foundation Trust, Manchester, UK
  1. Correspondence to Dr Liam Barrett, Emergency Department, Cambridge University Hospitals NHS Foundation Trust, CB2 0QQ, Cambridge, UK; liam.barrett{at}addenbrookes.nhs.uk

https://doi.org/10.1136/emermed-2022-212922

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    This month’s update is from the Emergency Medicine team in Cambridge. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.

    The papers are ranked as:

    • Worth a peek—interesting, but not yet ready for prime time.

    • Head turner—new concepts.

    • Game changer—this paper could/should change practice.

    Outcomes in patients with mild traumatic brain injury without acute intracranial traumatic injury by Madhok et al

    Topic:  trauma

    Outcome rating: head turner

    To appropriately advise our head-injured patients, emergency care practitioners need to understand the short-term and long-term functional outcomes of those with mild traumatic brain injury (TBI). In this prospective observational cohort study, Madhok et al performed an analysis of the American Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study, examining functional outcomes in patients with mild TBI (GCS score of 15 and a negative acute CT of the head, n=991).1

    Outcomes were the Glasgow Outcome Scale-Extended (GOS-E) and the Rivermead Post Concussion Symptoms Questionnaire (RPQ) total score at 2 weeks and again at 6 months post-injury. At 2 weeks and at 6 months, 73% and 56% of patients had an incomplete functional recovery (denoted by GOS-E <8), respectively. Patients with incomplete functional recovery also had higher RPQ scores, indicating greater levels of post-concussive symptoms.

    The study had some important exclusion criteria limiting generalisability such as those patients who: did not undergo cross-sectional imaging, were pregnant, were suffering significant mental health problems and (in most sites) did not speak English.

    Given the study finding that substantial numbers of patients with ‘mild’ TBI have significant functional impairment at 6 months post-injury, the authors recommend routine 2-week follow-up to identify and refer patients for neurological rehabilitation. However, provision of this healthcare resource would …

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    Footnotes

    • Twitter @liam126, @danw1310, @edbarn

    • Contributors LB led the team and was responsible for submission. OH, JP, DPW, SR, TA and LB reviewed papers. EBGB and AJNJ provided senior academic input.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.