Efficacy and safety of early administration of 4-factor prothrombin complex concentrate in patients with trauma at risk of massive transfusion. The PROCOAG randomized clinical trial.

Dehghan M, Nauth A, Schemitsch E, Vicente M, Jenkinson R, Kreder H et al, for the Canadian Orthopaedic Trauma Society and the Unstable Chest Wall RCT Study Investigators.

JAMA Surg 2022; 157: 983-990.

The study included 207 patients followed for up to 30 days. Ventilator-free days were higher in the operated group (22.7 versus 20.6; mean difference 2.1 days, P=0.09), and mortality was lower (0 versus 6, P=0.01). The advantage was mainly seen in patients ventilated at time of randomization. Complications rates and length of stay were similar.

Comment: Good study, but relatively modest benefit seen from surgery.

The PATCH-Trauma Investigators and the ANZICS Clinical Trials Group.

N Engl J Med 2023; 389: 127-136.

This multicentre study included 1310 injured patients randomly allocated tranexamic acid. After six months, rates of survival with favourable functional outcome were similar: 53.7 per cent with tranexamic acid compared to 53.5 per cent in controls, P=0.95.

Comment: Much of the literature about tranexamic acid is positive, and this requires further analysis and explanation.

Gyedu A, Stewart BT, Nakua E, Donkor P.

Br J Surg 2023; 110: 1473-1481.

Eight non-tertiary hospitals in Ghana used an adapted WHO Trauma Care Checklist. Documentation of the trauma injury improved in hospitals where the checklist was used after training, as did mortality in 302 patients with severe trauma, from 17.1 to 12.1 per cent, P=0.009.

Comment; Another great example of how a structured approach brings tangible benefits.