Journal update monthly top five

This month’s update comes from the Royal Melbourne Hospital ED in Victoria, Australia. 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 highlighted the main findings, key limitations and clinical bottom line for each paper. The papers are ranked as: Topic: Paediatric trauma Rating: Game Changer Children with traumatic abdominal and head injuries frequently present to the ED. Since only 2% require acute interventions,1 determining who can be safely managed without CT imaging is important. This study prospectively investigated whether the Paediatric Emergency Care Applied Research Network (PECARN) prediction rules could accurately risk-stratify patients with intra-abdominal or head injuries and determine which patients require CT imaging.1 This study was performed across level 1 paediatric trauma centres in the USA between 2016 and 2021. 7542 children with blunt abdominal trauma and 19 999 children with minor head trauma (defined by GCS>14 following blunt head trauma) were enrolled. The primary outcome for the abdominal trauma cohort was intra-abdominal injury requiring acute intervention, and the primary outcome for the traumatic brain injury (TBI) cohort included those requiring neurosurgery, intubation >24 hours post-injury or death. Children who did not have CT imaging were followed up 7 days or later after their ED visit to identify those that subsequently met the primary outcomes. Few true cases were missed for both rules. Sensitivities were 100% (95% CI 98% to 100%) for the intra-abdominal injury rule, 100% (95% CI 93.1% to 100.0%) for the TBI rule for children <2 years and 98.8% (95% CI 95.8% to 99.9) for the TBI rule for children >2 …