IntroductionResearch into therapeutic hypothermia following traumatic brain injury has been characterised by small trials of poor methodological quality, producing variable results. The Cochrane review, published in 2009, now requires updating. The aim of this systematic review is to assess the effectiveness of the application of therapeutic hypothermia to reduce death and disability when administered to adult patients who have been admitted to hospital following traumatic brain injury.MethodsTwo authors extracted data from each trial. Unless stated in the trial report, relative risks and 95% confidence intervals (CIs) were calculated for each trial. We considered P < 0 · 05 to be statistically significant. We combined data from all trials to estimate the pooled risk ratio (RR) with 95% confidence intervals for death, unfavourable outcome, and pneumonia. All statistical analyses were performed using RevMan 5.1 (Cochrane IMS, Oxford, UK) and Stata (Intercooled Version 12.0, StataCorp LP). Pooled RRs were calculated using the Mantel-Haenszel estimator. The random effects model of DerSimonian and Laird was used to estimate variances for the Mantel-Haenszel and inverse variance estimators.ResultsTwenty studies are included in the review, while 18 provided mortality data. When the results of 18 trials that evaluated mortality as one of the outcomes were statistically aggregated, therapeutic hypothermia was associated with a significant reduction in mortality and a significant reduction in poor outcome. There was a lack of statistical evidence for an association between use of therapeutic hypothermia and increased onset of new pneumonia.ConclusionsIn contrast to previous reviews, this systematic review found some evidence to suggest that therapeutic hypothermia may be of benefit in the treatment of traumatic brain injury. The majority of trials were of low quality, with unclear allocation concealment. Low quality trials may overestimate the effectiveness of hypothermia treatment versus standard care. There remains a need for more, high quality, randomised control trials of therapeutic hypothermia after traumatic brain injury.PROSPERO Systematic Review Registration Number 2012: CRD42012002449.

Are patients who use emergency kits less unwell on presentation than those who do not?  Comparative study with other centres. From a database of patients on hydrocortisone, 81 patients with diagnosis of Addison's disease, and an age-matched group of 66 patients with nonfunctioning pituitary adenoma or craniopharyngioma were selected. Details of all acute presentations to hospital over the last 6 years (June 2006-June 2012) extracted from patient records. Telephone questionnaire tested patients' knowledge of 'sick day rules.' Free answers were matched to the most similar option. To assess:  Demographics and clinical characteristics of patients with adrenal insufficiency presenting to hospital.  Frequency of presentations.  Patients' knowledge of crisis-preventing behaviours ('sick day rules').  Prevalence and views about emergency injectable hydrocortisone kits.  Influence of knowledge of crisis-preventing behaviours and use of emergency kits on presentation rates/clinical features on presentation.  Whether there are differences in these features between patients with PAI and SAI.