Article Figures & Data
Figures
- Figure 1
Study profile of participant selection, study groups and primary outcome results. DVT, deep vein thrombosis; ISS, injury severity score; MT, massive transfusion; PE, pulmonary embolism; TXA1, tranexamic acid administered during treatment; TXA0, tranexamic acid not administered during treatment; TXA-Missing, tranexamic acid administration information is missing from medical chart.
Tables
- Table 1
Demographic data and group characteristics for all trauma patients with a MT and ISS >10 who received TXA, did not receive TXA and those who were missing TXA information from 2009 to 2014
Characteristic TXA1
(318)TXA0
(38)TXA-Missing (264) Demographic data Age mean (SD) 24.5 (4.6) 25.6 (5.2) 25.0 (5.1) Gender (% male) 100% 100% 99.2% Service b ranch Air force, no. (%) 3 (0.9%) 1 (2.6%) 9 (3.4%) Army, no. (%) 155 (48.7%) 27 (71.1%) 159 (60.2%) Marine, no. (%) 152 (47.8%) 10 (26.3%) 91 (34.5%) Navy, no. (%) 8 (2.5%) 0 (0%) 5 (1.9%) Injury t ype Blunt, no. (%) 16 (5.0%) 3 (7.9%) 34 (12.9%) Burn, no. (%) 5 (1.6%) 2 (5.3%) 1 (0.4%) Penetrating, no. (%) 297 (93.4%) 33 (86.8%) 229 (86.7%) Mechanism of injury Bullet/GSW/Firearm, no. (%) 33 (10.4%) 6 (15.8%) 29 (11.0 %) Crush, no. (%) 1 (0.3%) 0 (0%) 1 (0.4%) Explosive, no. (%) 279 (87.7%) 31 (81.6%) 229 (86.7%) Helicopter crash, no. (%) 3 (0.9%) 0 (0%) 0 (0%) Knife or sharp object, no. (%) 1 (0.3%) 0 (0%) 0 (0%) Machinery/Equipment, no. (%) 0 (0%) 0 (0%) 1 (0.4%) MVC, no. (%) 1 (0.3%) 0 (0%) 3 (1.1%) Pedestrian, no. (%) 0 (0%) 1 (2.6%) 0 (0%) Plane crash, no. (%) 0 (0%) 0 (0%) 1 (0.4%) Composite ISS Mean (SD) 30.7 (13.0) 31.9 (16.0) 29.6 (12.6) AIS Head/Neck mean (SD) 1.3 (1.5) 1.3 (1.6) 1.5 (1.5) Face mean (SD) 0.8 (0.7) 0.7 (0.9) 0.7 (0.8) Chest/Thorax mean (SD) 1.2 (1.6) 1.8 (1.7) 1.5 (1.6) Abdomen mean (SD) 1.9 (1.5) 1.9 (1.5) 1.8 (1.5) Extremities mean (SD) 3.7 (1.3) 3.2 (1.5) 3.4 (1.3) Skin mean (SD) 1.5 (0.7) 1.6 (1.2) 1.5 (0.9) Estimated blood loss (m L ) in first 24 hours Mean (SD) 1996.8 (2489.0) 2881.3 (2940.2) 2071.8 (2321.8) F irst 24 hours transfusion, units PRBC mean (SD) 24.2 (15.2) 24.4 (15.9) 22.2 (12.7) Whole blood mean (SD) 1.2 (3.5) 3.3 (7.2) 1.8 (5.5) FFP mean (SD) 22.3 (14.7) 20.6 (18.0) 19.2 (12.1) Platelets mean (SD) 4.7 (3.7) 4.0 (4.2) 3.8 (2.9) Cryoprecipitate mean (SD) 9.5 (12.6) 10.6 (15.4) 7.2 (8.5) Miscellaneous Tourniquet used, no. (%) 244 (76.7%) 29 (76.3%) 175 (66.3%) Days in ICU, mean (SD) 13.8 (13.4) 24.8 (68.3) 12.1 (11.3) Days in hospital, mean (SD) 34.7 (35.1) 53.5 (84.8) 37.0 (38.4) Days on ventilator, mean (SD) 8.2 (8.2) 11.9 (19.1) 7.3 (8.2) AIS, Abbreviated Injury Score; FFP, fresh frozen plasma; GSW, gun shot wound; ICU, intensive care unit; ISS, injury severity score; MT, massive transfusion; MVC, motor vehicle crash; PRBC, packed red blood cells; SD, standard deviation; TXA0, tranexamic acid not administered during treatment; TXA1, tranexamic acid administered during treatment; TXA-Missing, tranexamic acid administration information is missing from medical chart.
- Table 2
Counts and percentages of TXA in the complete cases and for the imputed missing values
TXA Complete cases
N (%)Imputed cases
N (%)TXA1 318 (89.3) 181 (68.5) TXA0 38 (10.7) 83 (31.5) TXA0, tranexamic acid not administered during treatment; TXA, tranexamic acid; TXA1, tranexamic acid administered during treatment.
- Table 3
Parameter estimates using the Lasso method and the corresponding effect on the OR when using TXA1
Predictor variable VTE Pulmonary embolism Deep vein thrombosis Parameter
estimateOR Parameter
estimateOR Parameter
estimateOR Mechanism of injury: MVC 1.541 4.669 2.000 7.389 0.000 – Mechanism of injury: knife/sharp object 1.405 4.076 0.000 – 2.762 15.831 Injury type: burn −0.957 0.384 −0.581 0.559 0.000 – Mechanism of injury: bullet/GSW/firearm −0.505 0.604 0.000 – −0.591 0.554 Tourniquet −0.284 0.753 0.000 – −0.307 0.736 Mechanism of injury: crush −0.197 0.821 0.000 – 0.000 – Service branch: air force 0.187 1.206 0.000 – 0.000 – Service branch: marine 0.181 1.198 0.000 – 0.000 – Injury type: penetrating 0.077 1.080 0.000 – 0.000 – AIS abdomen 0.071 1.074 0.044 1.045 0.000 – First 24 hours transfusion: platelets 0.034 1.035 0.000 – 0.064 1.066 First 24 hours transfusion: whole blood −0.027 0.973 −0.021 0.979 0.000 – Days in ICU 0.009 1.009 0.000 – 0.003 1.003 Mechanism of injury: explosive 0.005 1.005 0.000 – 0.000 – Days in hospital 0.004 1.004 0.001 1.001 0.004 1.004 Days on ventilator 0.001 1.001 0.009 1.009 0.000 – AIS skin 0.000 – 0.000 – 0.000 – First 24 hours transfusion: PRBC 0.000 – 0.000 – 0.000 – First 24 hours transfusion: cryoprecipitate 0.000 – 0.000 – 0.000 – First 24 hours transfusion: FFP 0.000 – 0.000 – 0.000 – Estimated blood loss first 24 hours 0.000 – 0.000 – 0.000 – Age 0.000 – 0.004 1.004 0.000 – Injury year 0.000 – 0.072 1.075 0.000 – Composite ISS 0.000 – 0.000 – 0.000 – TXA1 0.000 – 0.000 – 0.000 – AIS head/neck 0.000 – 0.000 – 0.000 – AIS face 0.000 – 0.000 – 0.000 – AIS chest/thorax 0.000 – 0.000 – 0.000 – AIS extremities 0.000 – 0.111 1.117 0.000 – Service branch: army 0.000 – 0.000 – −0.739 0.478 Service branch: navy 0.000 – −0.326 0.722 0.000 – Mechanism of injury: helicopter crash 0.000 – −0.021 0.979 0.000 – Mechanism of injury: pedestrian 0.000 – 0.000 – 0.000 – Injury type: blunt 0.000 – 0.000 – 0.000 – The variables are sorted by the magnitude of theparameter estimates for VTE.
FFP, fresh frozen plasma; GSW, gun shot wound; ICU, intensive care unit; ISS, injury severity score; MVC, motor vehicle crash; PRBC, packed red blood cell; TXA, tranexamic acid; VTE, venous thromboembolism.
- Table 4
Parameter estimates using the Lasso method and the corresponding effect on the OR when using TXA_noblank
Predictor variable VTE Pulmonary embolism Deep vein thrombosis Parameter estimate OR Parameter estimate OR Parameter estimate OR Injury type: burn −0.866 0.421 −0.315 0.730 0.000 – Mechanism of injury: knife/sharp object 0.730 2.075 0.000 – 1.838 6.284 Service branch: navy −0.133 0.875 −0.129 0.879 0.000 – AIS extremities 0.077 1.080 0.198 1.219 0.000 – Service branch: marine 0.037 1.038 0.000 – 0.000 – Mechanism of injury: MVC 0.033 1.034 0.725 2.065 0.000 – Days in ICU 0.018 1.018 0.000 – 0.007 1.007 AIS abdomen 0.016 1.016 0.013 1.013 0.000 – First 24 hours transfusion: platelets 0.014 1.014 0.000 – 0.047 1.048 Tourniquet −0.013 0.987 0.000 – −0.092 0.912 First 24 hours transfusion: whole blood −0.008 0.992 −0.015 0.985 0.000 – Days in hospital 0.005 1.005 0.006 1.006 0.004 1.004 Service branch: air force 0.002 1.002 0.000 – 0.219 1.245 Composite ISS 0.000 – 0.000 – 0.000 – First 24 hours transfusion: PRBC 0.000 – 0.000 – 0.000 – First 24 hours transfusion: cryoprecipitate 0.000 – 0.000 – 0.000 – First 24 hours transfusion: FFP 0.000 – 0.000 – 0.002 1.002 Estimated blood loss first 24 hours 0.000 – 0.000 – 0.000 – Age 0.000 – 0.000 – 0.000 – Injury year 0.000 – 0.011 1.011 0.000 – Days on ventilator 0.000 – 0.000 – 0.000 – TXA_noblank 0.000 – 0.000 – 0.000 – AIS head/neck 0.000 – 0.000 – 0.000 – AIS face 0.000 – 0.000 – 0.000 – AIS chest/thorax 0.000 – 0.000 – 0.000 – AIS skin 0.000 – 0.000 – 0.011 1.011 Service branch: army 0.000 – 0.000 – −0.217 0.805 Mechanism of injury: bullet/GSW/firearm 0.000 – 0.000 – −0.006 0.994 Mechanism of injury: crush 0.000 – 0.000 – 0.228 1.256 Mechanism of injury: explosive 0.000 – 0.000 – 0.000 – Mechanism of injury: helicopter crash 0.000 – 0.000 – 0.000 – Mechanism of injury: machinery/equipment 0.000 – 0.000 – 0.000 – Mechanism of injury: pedestrian 0.000 – 0.000 – 0.000 – Mechanism of injury: plane crash 0.000 – 0.000 – 0.000 – The variables are sorted by the magnitude of the parameter estimates for VTE.
FFP, fresh frozen plasma; GSW, gun shot wound; ICU, intensive care unit; ISS, injury severity score; MVC, motor vehicle crash; PRBC, packed red blood cell; TXA, tranexamic acid; VTE, venous thromboembolism.
- Table 5
Parameter estimates using the Lasso method and the corresponding effect on the OR when imputing values with MICE for missing values of TXA1
Predictor variable VTE Pulmonary embolism Deep vein thrombosis Parameter
estimateOR Parameter
estimateOR Parameter
estimateOR Injury type: burn −0.606 0.546 −0.283 0.754 −0.541 0.582 Mechanism of injury: knife/sharp object 0.402 1.495 0.000 – 2.325 10.227 AIS extremities 0.071 1.074 0.167 1.182 0.000 – Mechanism of injury: plane crash −0.070 0.932 0.000 – −0.618 0.539 Mechanism of injury: MVC 0.061 1.063 0.488 1.629 0.055 1.057 Service branch: navy −0.053 0.948 −0.147 0.863 0.000 – Service branch: marine 0.033 1.034 0.000 – 0.000 – TXA1 0.030 1.030 0.090 1.094 −0.084 0.919 Service branch: air force 0.029 1.029 0.000 – 0.413 1.511 Days in ICU 0.017 1.017 0.000 – 0.009 1.009 Tourniquet −0.015 0.985 0.000 – −0.253 0.776 First 24 hours transfusion: platelets 0.013 1.013 0.000 – 0.053 1.054 Days in hospital 0.005 1.005 0.005 1.005 0.005 1.005 AIS abdomen 0.004 1.004 0.009 1.009 0.000 – First 24 hours transfusion: whole blood −0.003 0.997 −0.008 0.992 0.000 – First 24 hours transfusion: PRBC 0.000 – 0.000 – 0.000 – First 24 hours transfusion: cryoprecipitate 0.000 – 0.000 – 0.000 – First 24 hours transfusion: FFP 0.000 – 0.000 – 0.003 1.003 Estimated blood loss first 24 hours 0.000 – 0.000 – 0.000 – Age 0.000 – 0.000 – 0.000 – Injury year 0.000 – 0.004 1.004 0.000 – Composite ISS 0.000 – 0.000 – 0.000 – Days on ventilator 0.000 – 0.000 – 0.000 – AIS head/neck 0.000 – 0.000 – 0.000 – AIS face 0.000 – 0.000 – 0.000 – AIS chest/thorax 0.000 – 0.000 – 0.000 – AIS skin 0.000 – 0.000 – 0.068 1.070 Service branch: army 0.000 – 0.000 – −0.369 0.691 Mechanism of injury: bullet/GSW/firearm 0.000 – 0.000 – −0.192 0.825 Mechanism of injury: crush 0.000 – 0.000 – 0.722 2.059 Mechanism of injury: explosive 0.000 – 0.000 – 0.000 – Mechanism of injury: helicopter crash 0.000 – 0.000 – 0.000 – Mechanism of injury: machinery/equipment 0.000 – 0.000 – 0.000 – Mechanism of injury: pedestrian 0.000 – 0.000 – 0.000 – The variables are sorted by magnitude of the parameter estimates for VTE.
FFP, fresh frozen plasma; GSW, gun shot wound; ICU, intensive care unit; ISS, injury severity score; MICE, multiple imputation using chained equations; MVC, motor vehicle crash; PRBC, packed red blood cell; VTE, venous thromboembolism.
