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.

Is trauma centre care helpful for less severely injured patients?

Injury ◽  
2005 ◽  
Vol 36 (11) ◽  
pp. 1293-1297 ◽  
Author(s):  
Thomas S. Helling ◽  
Paul W. Nelson ◽  
B. Todd Moore ◽  
Denise Kintigh ◽  
Kathy Lainhart
Keyword(s):  
Trauma Centre ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Injured Patients

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.

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 Acute trauma coagulopathy: prevalence and outcome in trauma patients presenting to the Emergency Department SMBB Trauma Centre, Civil Hospital Karachi.

2021 ◽  
Author(s):  
Fariha Ashraf ◽  
Mohammad Faisal Ibrahim ◽  
Rabia Feroz ◽  
Abdul Wasey ◽  
Muhammad Arsalan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Injury Severity ◽  
Trauma Centre ◽  
P Value ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Acute Trauma ◽  
Civil Hospital ◽  
Injured Patients

Abstract PURPOSE To determine the prevalence of Acute Trauma Coagulopathy (ATC) in severely injured patients presenting to the emergency department of SMBB Trauma Centre of Civil Hospital Karachi and to investigate its impact on these patient's outcome. Early recognition using initial coagulation profile (PT/APTT) accompanied by adequate management of ATC and prevention of bleeding may substantially reduce mortality and improve outcomes in severely injured patients in resource limited environments. MATERIAL AND METHODS This descriptive cross sectional study was carried out in Surgical unit 4, Dr Ruth K.M. Pfau Civil hospital Karachi from 27 th July 2019 to 28 th January 2020. After approval from institutional review board, 80 patients aged between 14 to 60 years with injury severity score more than 15 were enrolled using non probability consecutive sampling technique and their coagulation profile (PT, APTT and INR) was done at presentation and followed for in hospital mortality. Data was collected and analyzed using SPSS 24. RESULTS In our study total 80 patients were enrolled, the mean age of patients was 27.28±12.18. Trauma coagulopathy was present in 12.5% patients. In hospital mortality was found to be 16.3%. The in hospital mortality was compared in patients with coagulopathy and patients without coagulopathy and p value was significant 0.00. Data stratification was significant for age with p value 0.016. Data stratification for gender, mode of injury, mechanism of injury, amount of fluid given at presentation and injury severity score was not significant. CONCLUSION Acute trauma coagulopathy is associated with increased risk of mortality.

Undertriage of the elderly major trauma patient continues in major trauma centre care: a retrospective cohort review

2020 ◽  
pp. emermed-2019-208541
Author(s):  
Antonia C Hoyle ◽  
Leela C Biant ◽  
Mike Young
Keyword(s):  
Older Patients ◽  
Major Trauma ◽  
Trauma Team ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Major Trauma Centre ◽  
Trauma Triage ◽  
Injured Patients

BackgroundMajor trauma (Injury Severity Score (ISS) ≥16) in older people is increasing, but concerns persist that major trauma is not always recognised in older patients on triage. This study compared undertriage of older and younger adult major trauma patients in the major trauma centre (MTC) setting to investigate this concern.MethodsA retrospective review of Trauma Audit and Research Network data was conducted for three MTCs in the UK for 3 months in 2014. Age, ISS, injury mechanism and injured areas were examined for all severely injured patients (ISS ≥16) and appropriate major trauma triage rates measured via the surrogate markers of trauma team activation and the presence of a consultant first attender, as per standards for major trauma care set by National Confidential Enquiry into Patient Outcomes and Deaths, Royal College of Surgeons of England and the British Orthopaedic Association. Trends in older (age ≥65) and younger (ages 18–64) adult major trauma presentation, triage and reception were reviewed.ResultsOf 153 severely injured patients, 46 were aged ≥65. Older patients were significantly less likely to receive the attention of a consultant first attender or trauma team. Similar trends were also seen on subgroup analysis by mechanism of injury or number of injured body areas. Older major trauma patients exhibit a higher mortality, despite a lower median ISS (older patient ISS=20 (IQR 16–25), younger patient ISS=25 (IQR 18–29)).ConclusionOlder major trauma patients are at greater risk of undertriage, even in the MTC environment. Existing hospital trauma triage practices should be further investigated to explain and reduce undertriage of elderly trauma patients.

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