Use of rFVIIa in the Trauma Setting–Practice Patterns in United States Trauma Centers

Much excitement has been generated regarding the off label use of recombinant factor VIIa (rFVIIa) in the severely injured trauma patient. The purpose of our study is 3-fold: 1) describe the type of centers that use rFVIIa, 2) determine which centers use the drug more frequently, and finally 3) investigate how this drug is being administered at trauma centers. A survey was mailed or e-mailed to 435 trauma centers (Level I and II) throughout the nation. One hundred fifty-six surveys were returned. American College of Surgeons (ACS) verification and trauma Level I designation were independent predictors of rFVIIa use (odds ratio [OR] 3.74 and 5.40, P < 0.05). High users of rFVIIa were defined as those centers that had above median usage of the drug. Level I centers accounted for 67 per cent of the high users. Only the number of fellowship-trained trauma surgeons and trauma volume predicted high usage of rFVIIa (OR 1.38 and 14.09, P < 0.05). Trauma volume predicted whether or not Factor VII users implemented a protocol based approach to administration of the drug (OR 6.57, P < 0.05). Most protocols incorporated packed red blood cells (74%) before giving rFVIIa. The dose of 90 mcg/kg was exceeded in 34 per cent of centers, and 3 per cent used the 200 mcg/kg dose. High volume Level I trauma centers use rFVIIa more frequently and are more likely to use a systematic approach to its administration. However, there is no standardized approach to rFVIIa administration in United States trauma centers.

Download Full-text

Variation in Use of Damage Control Laparotomy for Trauma By Trauma Centers in the United States, Canada, and Australasia

10.21203/rs.3.rs-728617/v1 ◽

2021 ◽

Author(s):

Derek J. Roberts ◽

Peter D. Faris ◽

Chad G. Ball ◽

Andrew W. Kirkpatrick ◽

Ernest E. Moore ◽

...

Keyword(s):

United States ◽

Damage Control ◽

High Volume ◽

The United States ◽

Trauma Centers ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Frequency Of Use ◽

Volume Level ◽

Level 1

Abstract Background: It is unknown how frequently damage control (DC) laparotomy is used across trauma centers in different countries. We conducted a cross-sectional survey of trauma centers in the United States, Canada, and Australasia to study variations in use of the procedure and predictors of more frequent use of DC laparotomy.Methods: A self-administered, electronic, cross-sectional survey of trauma centers in the United States, Canada, and Australasia was conducted. The survey collected information about trauma center and program characteristics. It also asked how often the trauma program director estimated DC laparotomy was performed on injured patients at that center on average over the last year. Multivariable logistic regression was used to identify predictors of a higher reported frequency of use of DC laparotomy.Results: Of the 366 potentially eligible trauma centers sent the survey, 199 (51.8%) trauma program directors or leaders responded [United States=156 (78.4%), Canada=26 (13.1%), and Australasia=17 (8.5%)]. The reported frequency of use of DC laparotomy was highly variable across trauma centers. DC laparotomy was used more frequently in level-1 than level-2 or -3 trauma centers. Further, high-volume level-1 centers used DC laparotomy significantly more often than lower volume level-1 centers (p=0.02). Nearly half (48.4%) of high-volume volume level-1 trauma centers reported using the procedure at least once weekly. Significant adjusted predictors of more frequent use of DC laparotomy included country of origin [odds ratio (OR) for the United States vs. Canada=7.49; 95% confidence interval (CI)=1.39-40.27], level-1 verification status (OR=6.02; 95% CI=2.01-18.06), and the assessment of a higher number of severely injured (Injury Severity Scale score >15) patients (OR per-100 patients=1.62; 95% CI=1.20-2.18) and patients with penetrating injuries (OR per-5% increase=1.27; 95% CI=1.01-1.58) in the last year.Conclusions: The reported frequency of use of DC laparotomy was highly variable across trauma centers. Those centers that most need to evaluate the benefit-to-risk ratio of using DC laparotomy in different scenarios may include high-volume, level-1 trauma centers, particularly those that often manage penetrating injuries.

Download Full-text

Massive Transfusion in Wartime: Experience from Northern Israel, Summer 2006.

Blood ◽

10.1182/blood.v110.11.4017.4017 ◽

2007 ◽

Vol 110 (11) ◽

pp. 4017-4017

Author(s):

Eldad J. Dann ◽

Najib Dally ◽

Judith Chezar ◽

Moshe Michaelson ◽

Mirit Barzelay ◽

...

Keyword(s):

Injury Severity ◽

Massive Transfusion ◽

Secondary Trauma ◽

Fresh Frozen Plasma ◽

Factor Vii ◽

Packed Red Blood Cells ◽

Medical Centers ◽

Fresh Frozen ◽

Level I ◽

Frozen Plasma

Abstract In July 2006 hostilities erupted in Israel/Lebanon. Reported here is the experience of three medical centers in Northern Israel during 33 days of the warfare; the Rambam Health Care Campus in Haifa - a level I trauma center, the Rebecca Sieff Hospital in Safed and the Western Galilee Hospital in Nahariah - both secondary trauma centers. 504, 1138 and 868 wounded were presented to the three medical centers and 281, 415 and 195, respectively, required hospitalization. Sixty, 32 and 15 hospitalized patients were concomitantly transfused in each corresponding center, representing 20%, 7% and 7%, respectively, of admitted patients. Patients with an injury severity score of ≥16 had a higher need for blood products than those less severely injured, with a mean packed red blood cell (PRBC) transfusion of 7 versus 4 units (p=0.03) and FFP transfusion of 13 versus 1.5 units (p=0.002), respectively. Twenty four soldiers and one civilian had massive transfusions and twenty three of these patients survived. The median ratio between transfused fresh frozen plasma (FFP) and packed red blood cells (PRBC) was 0.8, ranging from a ratio of 0.25 to 1.3. Among 25 massively transfused patients 21 received cryoprecipitate and 19 - platelets. The median prothrombin time (INR) and partial thromboplastin time (PTT) increased during the first 2 hours after admission from 1.29 to 1.51 and from 33.6 seconds to 39 seconds, respectively. In the cohort of massively transfused patients 3 individuals additionally received 3 g of tranexamic acid, while another 2 patients were treated with recombinant factor VII. In conclusion, massively transfused patients with wartime penetrating injuries have an ongoing coagulopathy despite vigorous replacement therapy, which needs to be continued until the patients are stabilized. Early intervention and consultation in the Emergency Room by transfusion-service specialists is essential to the overall management of critically and massively wounded patients in wartime. Wounded (hospitalized) Transfused patients Packed RBC units FFP units Cryo units Platelet units Massive transfusion (patients) Rambam 504 (281) 60 463 413 266 258 21 Rebecca Sieff 1138 (415) 32 134 34 50 30 4 Western Galilee 868 (195) 15 71 68 51 10 1

Download Full-text

Mass Casualty Incident Management Preparedness: A Survey of the American College of Surgeons Committee on Trauma

The American Surgeon ◽

10.1177/000313481608201231 ◽

2016 ◽

Vol 82 (12) ◽

pp. 1227-1231 ◽

Cited By ~ 3

Author(s):

Aaron M. Lewis ◽

Salvador Sordo ◽

Leonard J. Weireter ◽

Michelle A. Price ◽

Leopoldo Cancio ◽

...

Keyword(s):

Public Transportation ◽

Mass Casualty Incident ◽

Mass Casualty ◽

Incident Management ◽

Trauma Centers ◽

Select Group ◽

Level Ii ◽

American College Of Surgeons ◽

Level I ◽

Trauma Surgeons

Mass casualty incidents (MCIs) are events resulting in more injured patients than hospital systems can handle with standard protocols. Several studies have assessed hospital preparedness during MCIs. However, physicians and trauma surgeons need to be familiar with their hospital's MCI Plan. The purpose of this survey was to assess hospitals’ and trauma surgeon's preparedness for MCIs. Online surveys were e-mailed to members of the American College of Surgeons committee on Trauma Ad Hoc Committee on Disaster and Mass Casualty Management before the March 2012 meeting. Eighty surveys were analyzed (of 258). About 76 per cent were American College of Surgeons Level I trauma centers, 18 per cent were Level II trauma centers. Fifty-seven per cent of Level I and 21 per cent of Level II trauma centers had experienced an MCI. A total of 98 per cent of respondents thought it was likely their hospital would see a future MCI. Severe weather storm was the most likely event (95%), followed by public transportation incident (86%), then explosion (85%). About 83 per cent of hospitals had mechanisms to request additional physician/surgeons, and 80 per cent reported plans for operative triage. The majority of trauma surgeons felt prepared for an MCI and believed an event was likely to occur in the future. The survey was limited by the highly select group of respondents and future surveys will be necessary.

Download Full-text

The Volume-Outcomes Relationship for United States Level I Trauma Centers

Journal of Surgical Research ◽

10.1016/j.jss.2010.05.020 ◽

2011 ◽

Vol 167 (1) ◽

pp. 19-23 ◽

Cited By ~ 39

Author(s):

Kyla M. Bennett ◽

Steven Vaslef ◽

Theodore N. Pappas ◽

John E. Scarborough

Keyword(s):

United States ◽

Trauma Centers ◽

Level I

Download Full-text

Influence of psychosocial and sociodemographic factors in the surgical management of traumatic cervicothoracic spinal cord injury at level I and II trauma centers in the United States

Journal of Spine Surgery ◽

10.21037/jss-21-37 ◽

2021 ◽

Vol 7 (3) ◽

pp. 277-288

Author(s):

Matthew J. Hagan ◽

Nathan J. Pertsch ◽

Owen P. Leary ◽

Bryan Zheng ◽

Joaquin Q. Camara-Quintana ◽

...

Keyword(s):

United States ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Management ◽

The United States ◽

Sociodemographic Factors ◽

Trauma Centers ◽

Cord Injury ◽

Level I

Download Full-text

Function of “Nontrauma” Surgeons in Level I Trauma Centers in the United States

World Journal of Surgery ◽

10.1007/pl00012286 ◽

1997 ◽

Vol 21 (5) ◽

pp. 564-568

Author(s):

James W. Pate

Keyword(s):

United States ◽

The United States ◽

Trauma Centers ◽

Level I

Download Full-text

Use of Recombinant Activated Factor VII in Severe Postpartum Haemorrhage: Data from the South European Registry. A Multicentric Observational Retrospective Study

Blood ◽

10.1182/blood.v112.11.4065.4065 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4065-4065

Author(s):

Giovanni Barillari ◽

Keyword(s):

Postpartum Haemorrhage ◽

Post Partum ◽

Factor Vii ◽

The South ◽

Recombinant Activated Factor Vii ◽

Packed Red Blood Cells ◽

Activated Factor Vii ◽

Rfviia Administration ◽

Transfusion Requirements ◽

Before And After

Abstract Introduction: Major Post Partum Haemorrhage (PPH) is a life threatening complication of labor, which mainly occurs without warning, predictive signs and symptoms and often in absence of predisposing conditions. A retrospective survey of cases of severe primary PPH treated with Recombinant Activated Factor VII (rFVIIa) in Italy, Greece, Spain and Portugal was performed. The aim of our study was to report the south european real experience in clinical practice about the use rFVIIa in PPH treatment. Methods: anamnestic, clinical and haemostatic data about fortyfive patients, treated between 2005 and 2007, were collected. Coagulative parameters and transfusion requirements before and after rFVIIa treatment were compared. Results: INR significantly decreased, while levels of fibrinogen markedly increased after rFVIIa administration. The median need of packed red blood cells units, platelets units, fresh frozen plasma and crystalloids and colloids, before and after rFVIIa administration, dramatically reduced being respectively 6 and 2 units (p<1.2exp-6), 1.5 and 0 units (p = 0.001), 1250 and 0 mL (p<4.4exp-5), 3000 and 1250mL (p<0,0042). No cases of adverse effects or thromboembolic complications were observed. Conclusions: Our clinical and haemostatic data suggest that recombinant activated factor VII may be a safe and helpful adjunctive therapy in the management of postpartum haemorrhage.

Download Full-text

The effect of orthopaedic surgeons’ and interventional radiologists’ availability on the priority treatment sequence for hemodynamically unstable pelvic fractures: a survey of US Level I trauma centers

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1417-1 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

S. Jarvis ◽

A. Orlando ◽

B. Blondeau ◽

K. Banton ◽

C. Reynolds ◽

...

Keyword(s):

Pelvic Fractures ◽

Orthopaedic Trauma ◽

Trauma Centers ◽

Treatment Sequence ◽

Cross Sectional Survey ◽

Pelvic Packing ◽

Study Objective ◽

Orthopaedic Surgeons ◽

Level I ◽

Trauma Surgeons

Abstract Background Most guidelines recommend both pelvic packing (PP) and angioembolization for hemodynamically unstable pelvic fractures, however their sequence varies. Some argue to use PP first because orthopaedic surgeons are more available than interventional radiologists; however, there is no data confirming this. Methods This cross-sectional survey of 158 trauma medical directors at US Level I trauma centers collected the availability of orthopaedic surgeons and interventional radiologists, the number of orthopaedic trauma surgeons trained to manage pelvic fractures, and priority treatment sequence for hemodynamically unstable pelvic fractures. The study objective was to compare the availability of orthopaedic surgeons to interventional radiologists and describe how the availability of orthopaedic surgeons and interventional radiologists affects the treatment sequence for hemodynamically unstable pelvic fractures. Fisher’s exact, chi-squared, and Kruskal-Wallis tests were used, alpha = 0.05. Results The response rate was 25% (40/158). Orthopaedic surgeons (86%) were on-site more often than interventional radiologists (54%), p = 0.003. Orthopaedic surgeons were faster to arrive 39% of the time, and interventional radiologists were faster to arrive 6% of the time. There was a higher proportion of participants who prioritized PP before angioembolization at centers with above the average number (> 3) of orthopaedic trauma surgeons trained to manage pelvic fractures, as among centers with equal to or below average, p = 0.02. Arrival times for orthopaedic surgeons did not significantly predict prioritization of angioembolization or PP. Conclusions Our results provide evidence that orthopaedic surgeons typically are more available than interventional radiologists but contrary to anecdotal evidence most participants used angioembolization first. Familiarity with the availability of orthopaedic surgeons and interventional radiologists may contribute to individual trauma center’s treatment sequence.

Download Full-text