the war in Iraq, and Hurricane Katrina have focused attention on posttraumatic stress disorder (PTSD), an anxiety disorder that can result from exposure to traumatic events like combat, rape, assault, and disaster. Posttraumatic stress disorder is characterized by symptoms of reexperiencing the traumatic event, avoiding reminders of the event or feeling emotionally numb, and hyperarousal. 1 The disorder is associated with psychiatric and physical comorbidity, reduced quality of life, 2-4 and substantial economic costs to society. 5 Lifetime prevalence in US adults is higher in women (9.7%) than in men (3.6%) 6 and is especially high among women who have served in the military. 3,7 Thus, research aimed at testing treatments for PTSD in this population is important.

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Strategies to reduce health inequalities need to take into account that high levels of exception reporting, particularly in practices with deprived populations, may be disguising unmet need in those populations.

In the context of traumatic brain injury (TBI), decompressive craniectomy (DC) is used as part of tiered therapeutic protocols for patients with intracranial hypertension (secondary or protocol-driven DC). In addition, the bone flap can be left out when evacuating a mass lesion, usually an acute subdural haematoma (ASDH), in the acute phase (primary DC). Even though, the principle of “opening the skull” in order to control brain oedema and raised intracranial pressure has been practised since the beginning of the 20th century, the last 20 years have been marked by efforts to develop the evidence base with the conduct of randomised trials. This article discusses the merits and challenges of this approach and provides an overview of randomised trials of DC following TBI. An update on the RESCUEicp study, a randomised trial of DC versus advanced medical management (including barbiturates) for severe and refractory post-traumatic intracranial hypertension is provided. In addition, the rationale for the RESCUE-ASDH study, the first randomised trial of primary DC versus craniotomy for adult head-injured patients with an ASDH, is presented.