Hypothesis: This project tested the hypothesis that computer-aided decision support during the first 30 minutes of trauma resuscitation reduces management errors.
Objectives ‘Massive’ transfusion is a poorly defined inclusion criteria for studies examining the blood and blood product that are used during trauma resuscitation. We aimed to compare the traditional definition of massive transfusion (≥10 units in 24 h) to a more acute definition of at least 5 units in 4 h. Methods Multitrauma patients were subgrouped according to the traditional definition and compared with the acute definition. Demographics, presenting vital signs and blood results, management including transfusion practice and outcomes were retrospectively studied. Associations of transfused fresh frozen plasma:packed red blood cells (PRBC) ratios with mortality were studied. Results There were 927 patients who received PRBCs in the first 24 h, with 314 patients identified using the traditional definition and 303 patients using the acute definition. The patients identified using the traditional definition received 18 (12–29) units of PRBC in 24 h, significantly higher than those identified using the acute definition [15 (9–29) units, P<0.001]. The traditional definition excluded a significant proportion of patients who died in the emergency department. By using the acute definition to select a study sample, there seems to be an increase in mortality with fresh frozen plasma:PRBC ratio of 1 : 1 ratio compared with a 1 : 2 ratio. Conclusion The traditional ‘massive’ transfusion definition not only ‘dilutes’ the potential study samples with a less acute group of patients, but also further excludes patients who die early. This latter group is most likely to be benefitted from any change to resuscitation practice. An acute definition of massive transfusion should be adopted when examining clinical practice during initial trauma resuscitation.
There is considerable interest in whether routine whole-body computed tomography (WBCT) imaging produces different patient outcomes in blunt trauma patients when compared with selective imaging. This article aimed to systematically review the literature for all outcomes measured in comparing WBCT with selective imaging in trauma patients and to evaluate the comprehensiveness of relevant dimensions for this comparison.We performed a systematic review of studies comparing WBCT and selective imaging approaches during the initial assessment of multitrauma patients. Peer-reviewed studies including cohort studies, randomized controlled trials, meta-analyses, and systematic reviews were identified through large database searches and filtered through methodologic inclusion criteria. Data on study characteristics, hypotheses and conclusions made, outcomes assessed, and references to potential benefits and harms were extracted.Eight retrospective cohort studies and two systematic reviews were identified. Six primary studies evaluated mortality as an outcome, and four studies found a significant difference in results favoring WBCT imaging over selective imaging. All five articles assessing various time intervals in hospital following imaging after injury found significantly reduced times with WBCT. Radiation exposure was found to be increased after WBCT imaging compared with selective imaging in the only study in which it was evaluated. The two systematic reviews analyzed the same three articles with regard to mortality but concluded differently about overall benefits.WBCT imaging seems to be associated with reduced times to events in hospital following traumatic injury and seems to be associated with decreased mortality. Whether this is a true effect mediated through an as yet unsubstantiated change in management or the result of hospital- or individual-level confounders is unclear. When evaluating these outcomes, it seems that the authors of both primary studies and systematic reviews have often been selective in their choice of short-term outcomes, painting an incomplete picture of the issue.Systematic review, level III.
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