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- Title
Introduction of a standardised protocol, including systematic use of tranexamic acid, for management of severe adult trauma patients in a low-resource setting: the MSF experience from Port-au-Prince, Haiti.
- Authors
Jachetti, Alessandro; Massénat, Rose Berly; Edema, Nathalie; Woolley, Sophia C.; Benedetti, Guido; Van Den Bergh, Rafael; Trelles, Miguel
- Abstract
<bold>Background: </bold>Bleeding is an important cause of death in trauma victims. In 2010, the CRASH-2 study, a multicentre randomized control trial on the effect of tranexamic acid (TXA) administration to trauma patients with suspected significant bleeding, reported a decreased mortality in randomized patients compared to placebo. Currently, no evidence on the use of TXA in humanitarian, low-resource settings is available. We aimed to measure the hospital outcomes of adult patients with severe traumatic bleeding in the Médecins Sans Frontières Tabarre Trauma Centre in Port-au-Prince, Haiti, before and after the implementation of a Massive Haemorrhage protocol including systematic early administration of TXA.<bold>Methods: </bold>Patients admitted over comparable periods of four months (December2015- March2016 and December2016 - March2017) before and after the implementation of the Massive Haemorrhage protocol were investigated. Included patients had blunt or penetrating trauma, a South Africa Triage Score ≥ 7, were aged 18-65 years and were admitted within 3 h from the traumatic event. Measured outcomes were hospital mortality and early mortality rates, in-hospital time to discharge and time to discharge from intensive care unit.<bold>Results: </bold>One-hundred and sixteen patients met inclusion criteria. Patients treated after the introduction of the Massive Haemorrhage protocol had about 70% less chance of death during hospitalization compared to the group "before" (adjusted odds ratio 0.3, 95%confidence interval 0.1-0.8). They also had a significantly shorter hospital length of stay (p = 0.02).<bold>Conclusions: </bold>Implementing a Massive Haemorrhage protocol including early administration of TXA was associated with the reduced mortality and hospital stay of severe adult blunt and penetrating trauma patients in a context with poor resources and limited availability of blood products.
- Subjects
PORT-au-Prince (Haiti); HAITI; HEMORRHAGE treatment; TRANEXAMIC acid; HOSPITAL mortality; TRAUMA centers; TRAUMATOLOGY; CRITICAL care medicine
- Publication
BMC Emergency Medicine, 2019, Vol 19, Issue 1, pN.PAG
- ISSN
1471-227X
- Publication type
journal article
- DOI
10.1186/s12873-019-0266-x