Standardized trauma intake form with clinical decision support prompts improves care and reduces mortality for seriously injured patients in non-tertiary hospitals in Ghana: stepped-wedge cluster randomized 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.

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.