Another month brings a fresh set of research articles, ranging from clinically relevant findings to thought-provoking observations. This roundup covers topics from transfusion strategies in traumatic brain injury to smoking cessation programs and the accuracy of patient self-prognosis.
Liberal vs. Restrictive Transfusion in Traumatic Brain Injury
A pragmatic, multicenter, open-label trial investigated liberal (hemoglobin <100 g/L) versus restrictive (hemoglobin <70 g/L) transfusion strategies in 742 adults with traumatic brain injury. While the trial was statistically negative for unfavorable functional outcomes at six months, there was a notable absolute difference (68.4% in the liberal group vs. 73.5% in the conservative group; ARR 5.4%, 95% CI -2.9 to 13.7%). According to Turgeon AF, Fergusson DA, Clayton L, et al., this result suggests a potential clinical relevance that necessitates a larger follow-up RCT. The unblinded nature and subjective outcome measures of the trial introduce a risk of bias, requiring careful clinical judgment considering both the potential harms and benefits of transfusion.
Smoking Cessation in the Emergency Department
The Cessation of Smoking Trial in the Emergency Department (COSTED) was a multicenter RCT across six UK emergency departments. It examined a smoking cessation intervention involving brief advice (up to 15 minutes), provision of an e-cigarette starter kit with advice (up to 15 minutes), and referral to local stop smoking services, compared to a control group receiving a pamphlet. Among 972 participants, the intervention significantly improved biochemically verified abstinence at 6 months (7.2% vs. 4.1%; ARR 3.3%, 95% CI 0.3% to 6.3%). While the study had limitations, such as a non-pure control group and feasibility concerns in busy EDs, the 3% absolute decrease in confirmed smoking is noteworthy.
Patient Self-Prognosis: How Well Do Patients Predict Their Outcomes?
A systematic review assessed patient self-prognosis, looking at outcomes like hospital admission, general health, and life expectancy. While comparisons between patient-perceived severity and injury severity scores (ISS) were deemed less reliable, the review highlighted that patients' expectations about their clinical course often differ from those of clinicians. Mols EM, Haak H, Holland M, et al., emphasize the importance of setting expectations and communicating clearly with patients.
Oral vs. IV Antibiotics for Pediatric Bone and Joint Infections
A nationwide, multicenter RCT in Denmark compared oral versus intravenous empirical antibiotics in children and adolescents with uncomplicated bone and joint infections. The primary outcome, sequelae of infection at 6 months, occurred in no patients in either group. Nielsen AB, Holm M, Lindhard MS, et al., found no significant differences in short-term outcomes like ICU use and septic shock. Although adverse events were higher in the oral group, the measured events were biased towards GI side effects, with no mention of IV-related complications. The study reinforces that oral antibiotics are at least as effective as IV antibiotics in these infections.
