Operative vs nonoperative treatment of acute unstable chest wall injuries. A randomized clinical trial.

Bouzat P, Charbit J, Abback P-S, Huet-Garrigue D, Delhaye N, Leone M et al, for the PROCOAG Study Group.

JAMA 2023; 329: 1367-1375.

In this study of 327 injured patients, use of the prothrombin complex did not reduce the need for blood transfusion within the first 24 hours: 12 versus 11 units, P=0.72. It did increase the risk of thrombotic events by around 11% , P=0.03

Comment: Disappointing results.

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.