RT Journal Article
SR Electronic
T1 Antifibrinolytics in a rural trauma state: assessing the opportunities
JF Trauma Surgery & Acute Care Open
FD BMJ Publishing Group Ltd
SP e000107
DO 10.1136/tsaco-2017-000107
VO 2
IS 1
A1 James M Bardes
A1 Amanda Palmer
A1 Jorge Con
A1 Alison Wilson
A1 Gregory Schaefer
YR 2017
UL http://tsaco.bmj.com/content/2/1/e000107.abstract
AB Background Tranexamic acid (TXA) has demonstrated improved mortality among trauma patients. However, recent evidence from urban US trauma centers has failed to show a benefit among the civilian population. TXA in rural states has not been evaluated. This study aimed to evaluate the current use of TXA in the rural trauma population.Methods A retrospective observational review at a level 1 trauma center based in a rural environment. Records were reviewed for TXA indications. TXA indication was defined as: systolic blood pressure <90 mm Hg, blood transfusion, or with a clinical concern for ongoing bleeding. Patients were ineligible if the time since injury was >3 hours.Results 400 patients were evaluated. 54% of patients met indications for TXA. 14% of these received TXA. 30.4% with an indication for TXA were ineligible due to arrival beyond 3 hours from time of injury. 135 patients arrived as transfers, 265 from the scene. There was no difference in TXA indications between scene and transfers (73 vs 144, p=1). Transfers were more likely to arrive beyond the 3-hour window (59 vs 7, p=0.001). Mortality for patients treated with TXA was 12.5%. This was not significantly different from patients not treated with TXA (19%).Discussion In a rural system, long transfers exclude most patients from treatment with TXA. A multicenter rural trauma center study will be needed to better define the optimal use of TXA in rural populations.Level of evidence Level IV data: therapeutic/care management.