Prehospital tranexamic acid for severe trauma.

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.

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.