The role of pharmacological steroid therapy in preservation of renal function in severely injured patients requiring massive transfusion

2015 ◽  
Vol 42 (4) ◽  
pp. 477-481
Author(s):  
F. A. Khan ◽  
A. M. Ledgerwood ◽  
C. E. Lucas
Keyword(s):  
Renal Function ◽  
Steroid Therapy ◽  
Massive Transfusion ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Injured Patients

Imaging Evaluation in the Early Management of Severely Injured Patients.

2021 ◽  
Author(s):  
Christopher Spering ◽  
Soehren Dirk Brauns ◽  
Bertil Bouillon ◽  
Mark-Tilmann Seitz ◽  
Katharina Jaeckle ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Thoracic Trauma ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Initial Management ◽  
Trauma Centres ◽  
Therapeutic Consequences ◽  
Time Period ◽  
Injured Patients

Abstract Introduction: The plain film chest x-ray in supine position (CXR) during the initial management of severely injured patients has almost lost its clinical relevance, since it has been challenged by extended focused assessment with sonography in trauma (eFAST) in early trauma management, due to its superiority in detecting a pneumo-/hematothorax. One of the last diagnostic fields in such setting of CXR is the mediastinal vascular injury. These injuries are rare yet life-threatening events. The most easily accessible diagnostic tool to identify these patients would be CXR as it is still one of the standard diagnostic tools in the early assessment of severely injured patients with significant thoracic trauma (Abbreviated Injury Scale, AIS ≥3). This study evaluates the role of early CXR in the Trauma Resuscitation Unit (TRU) in the last diagnostic field where eFAST cannot provide an answer: detecting mediastinal vascular injury in severely injured patients.Method: This retrospective, observational, single-centre study included all primary blunt trauma patients of a 24 months time period, that had been admitted to the TRU. Mediastinal/chest (M/C) ratio measurements were taken from CXRs at three defined levels of the mediastinum. The accuracy of the CXR findings were compared to whole-body computed tomography scans (WBCT) and therapeutic consequences were observed. Additionally a 15 years (2005–2019) time period out of the TraumaRegister DGU® was evaluated regarding usage of eFAST, CXR und WBCT in Level-1, -2, and − 3 Trauma Centres in Germany.Results: A total of 267 patients showed a significant blunt thoracic trauma (27 with mediastinal vascular injury (VThx)). The initial CXR in a supine position was unreliable for detecting mediastinal vascular injury. The sensitivity and specificity at different thresholds of maximum M/C ratio (2.0–3.0) were not clinically acceptable. The aortic contour and haemato- and pneumothorax were not reliably detected in the initial CXRs. No significant differences in the cardiac silhouette were observed between patients with or without mediastinal vascular injury (mean cardiac width, 136.5 mm, p = 0.44). No therapeutic consequences were drawn after CXR in the study period. The data from the TR-DGU (N = 251,095) showed a continuous reduction of CXR from 75% (2005) to 25% (2019), while WBCT raised from 35% to a steady level of about 80%. This development was seen in all trauma hospitals almost simultaneously.Conclusion: In present guidelines, CXR remains an integral diagnostic element during early TRU management, although several prior publications show the superior role of eFAST. Our data support that in most cases, CXR is time consuming and provides no benefit during initial management of severely injured patients and might delay the use of WBCT. The trauma centres in Germany have already significantly reduced the usage of CXR in the TRU. We therefore recommend to revise current guidelines and emphasise eFAST and rapid diagnostic through WBCT if rapidly available.

scholarly journals The impact of prehospital tranexamic acid on mortality and transfusion requirements: match-pair analysis from the nationwide German TraumaRegister DGU®

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Sebastian Imach ◽  
Arasch Wafaisade ◽  
Rolf Lefering ◽  
Andreas Böhmer ◽  
Mark Schieren ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Massive Transfusion ◽  
Control Group ◽  
Transfusion Rate ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Match Pair ◽  
Transfusion Requirements ◽  
Injured Patients ◽  
The Impact

Abstract Background Outcome data about the use of tranexamic acid (TXA) in civilian patients in mature trauma systems are scarce. The aim of this study was to determine how severely injured patients are affected by the widespread prehospital use of TXA in Germany. Methods The international TraumaRegister DGU® was retrospectively analyzed for severely injured patients with risk of bleeding (2015 until 2019) treated with at least one dose of TXA in the prehospital phase (TXA group). These were matched with patients who had not received prehospital TXA (control group), applying propensity score-based matching. Adult patients (≥ 16) admitted to a trauma center in Germany with an Injury Severity Score (ISS) ≥ 9 points were included. Results The matching yielded two comparable cohorts (n = 2275 in each group), and the mean ISS was 32.4 ± 14.7 in TXA group vs. 32.0 ± 14.5 in control group (p = 0.378). Around a third in both groups received one dose of TXA after hospital admission. TXA patients were significantly more transfused (p = 0.022), but needed significantly less packed red blood cells (p ≤ 0.001) and fresh frozen plasma (p = 0.023), when transfused. Massive transfusion rate was significantly lower in the TXA group (5.5% versus 7.2%, p = 0.015). Mortality was similar except for early mortality after 6 h (p = 0.004) and 12 h (p = 0.045). Among non-survivors hemorrhage as leading cause of death was less in the TXA group (3.0% vs. 4.3%, p = 0.021). Thromboembolic events were not significantly different between both groups (TXA 6.1%, control 4.9%, p = 0.080). Conclusion This is the largest civilian study in which the effect of prehospital TXA use in a mature trauma system has been examined. TXA use in severely injured patients was associated with a significantly lower risk of massive transfusion and lower mortality in the early in-hospital treatment period. Due to repetitive administration, a dose-dependent effect of TXA must be discussed.

The Role of Whole-Body Computed Tomography in Severely Injured Patients Retrospective Single Center Cohort Study

2016 ◽  
Vol 6 (1) ◽  
pp. 18-22
Author(s):  
Hyun-Woo Sun ◽  
Suk-Kyung Hong ◽  
Min-Ae Keum ◽  
Jong-Kwan Baek ◽  
Jung-Sun Lee ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cohort Study ◽  
Whole Body ◽  
Severely Injured ◽  
Single Center ◽  
Severely Injured Patients ◽  
Whole Body Computed Tomography ◽  
Injured Patients

Massive transfusion

2011 ◽  
Author(s):  
K. Boffard
Keyword(s):  
Intensive Care ◽  
Early Intervention ◽  
Intensive Care Units ◽  
Trauma Care ◽  
Massive Transfusion ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Trauma Surgeons ◽  
Injured Patients

♦ Treatment of anaemia has changed substantially since the early 1990s♦ Although massive transfusion may be necessary, trauma surgeons have modified their practice to provide aggressive control of haemorrhage, prevent hypothermia and acidosis, optimize haemodynamic management in intensive care units, and rationalize transfusion support in severely injured patients. The result has been an improvement in the outcomes of these patients♦ Given the importance of early intervention in the care of the injured, understanding the physiology and true indications for early massive transfusion in trauma care has the potential to save many lives.

scholarly journals mTICCS and its inter-rater reliability to predict the need for massive transfusion in severely injured patients

2020 ◽  
Author(s):  
Klemens Horst ◽  
Philipp Lichte ◽  
Felix Bläsius ◽  
Christian David Weber ◽  
Martin Tonglet ◽  
...  
Keyword(s):  
Massive Transfusion ◽  
Scoring Systems ◽  
Clinical Score ◽  
Trauma Centre ◽  
Medical Professionals ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Rater Reliability ◽  
Significant Difference ◽  
Injured Patients

Abstract Purpose The modified Trauma-Induced Coagulopathy Clinical Score (mTICCS) presents a new scoring system for the early detection of the need for a massive transfusion (MT). This easily applicable score was validated in a large trauma cohort and proven comparable to more established complex scoring systems. However, the inter-rater reliability of the mTICCS has not yet been investigated. Methods Therefore, a dataset of 15 randomly selected and severely injured patients (ISS ≥ 16) derived from the database of a level I trauma centre (2010–2015) was used. Moreover, 15 severely injured subjects that received MT were chosen from the same databank. A web-based survey was sent to medical professionals working in the field of trauma care asking them to evaluate each patient using the mTICCS. Results In total, 16 raters (9 residents and 7 specialists) completed the survey. Ratings from 15 medical professionals could be evaluated and led to an ICC of 0.7587 (95% Bootstrap confidence interval (BCI) 0.7149–0.8283). A comparison of working experience specific ICC (n = 7 specialists, ICC: 0.7558, BCI: 0.7076–0.8270; n = 8 residents, ICC: 0.7634, BCI: 0.7183–0.8335) showed no significant difference between the two groups (p = 0.67). Conclusion In summary, reliability values need to be considered when making clinical decisions based on scoring systems. Due to its easy applicability and its almost perfect inter-rater reliability, even with non-specialists, the mTICCS might therefore be a useful tool to predict the early need for MT in multiple trauma.

Whole Blood Thrombin Generation in Severely Injured Patients Requiring Massive Transfusion

2021 ◽  
Vol 232 (5) ◽  
pp. 709-716 ◽  
Author(s):  
Julia R. Coleman ◽  
Ernest E. Moore ◽  
Jason M. Samuels ◽  
Mitchell J. Cohen ◽  
Christopher C. Silliman ◽  
...  
Keyword(s):  
Whole Blood ◽  
Thrombin Generation ◽  
Massive Transfusion ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Injured Patients
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