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Journal update monthly top five
  1. Rahul Uday Nayak1,
  2. Shashank Ravi1,
  3. Pallavi Sai Kondayapalepu2,
  4. Deepthi Prabhakar3,
  5. Prasanthi Govindarajan1,
  6. Patricia Van Den Berg4
  1. 1 Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
  2. 2 Cornell University, Ithaca, New York, USA
  3. 3 Clemson University, Clemson, South Carolina, USA
  4. 4 Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
  1. Correspondence to Dr Prasanthi Govindarajan, Emergency Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; pgovinda{at}

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This month’s update is by the Department of Emergency Medicine, Stanford Medicine. 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.

The efficacy of prehospital IV fluid management in severely injured adult trauma patients: a systematic review and meta-analysis by Hébert et al

Topic: Intravenous fluid management

Outcome rating: worth a peek

An aggressive fluid resuscitation strategy has long been common practice for the treatment of trauma patients in haemorrhagic shock. Recent literature has suggested that restrictive fluid administration may be better for specific trauma populations. This systematic review and meta-analysis evaluated the effect of standard intravenous fluid therapy compared with no or low fluid administration for trauma patients in the prehospital setting.1

The investigators included 10 073 patients across six observational studies and 1 pilot randomised controlled trial. Both blunt and penetrating injuries were included with their trauma severity quantified by a systolic BP of ≤90 mm Hg or a shock index of >1. The primary outcome was mortality within 30 days. Overall, there was no difference in mortality between low-volume and high-volume fluid resuscitation relative risk (RR) of 0.99 (95% CI 0.80 to 1.22). Included studies differed in their focus. Some compared high-volume and low-volume fluid resuscitation, while others compared the presence or absence of intravenous fluid therapy adding significant heterogeneity. Additionally, the type of fluid used was not always specified but included different crystalloids and colloids in one study. The distinct lack of good quality randomised trials in this area should strongly be considered …

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  • RUN and SR are joint first authors.

  • Twitter @RahulNayakMD, @PrashaG2017

  • Contributors All authors have contributed in line with the ICMJE guidelines.

  • 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 Commissioned; internally peer reviewed.