J Trauma
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Mortality from trauma in rural areas is increased compared with the urban environment. We aimed to describe the relationship between trauma deaths and various categories of remoteness in rural areas, in Western Australia (WA). ⋯ We have quantified the direct relationship between remoteness and trauma deaths. In particular, the death rate in very remote areas is over four times the rate in major cities. Such data should be useful for the planning of trauma systems in these areas.
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Comment Letter Case Reports
Re: Removal of a bent intramedullary nail with a posttraumatic sagittal plane deformity.
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Randomized Controlled Trial
Abnormal coagulation tests are associated with progression of traumatic intracranial hemorrhage.
Intracranial hemorrhage (ICH) is common in traumatic brain injury (TBI) and a major determinant of death and disability. ICH commonly increases in size and coagulopathy has been implicated in such progression. We investigated the association between coagulopathy diagnosed by routine laboratory tests and ICH progression. ⋯ This study demonstrates an association between coagulopathy, diagnosed by routine laboratorial tests in the first 24 hours, with ICH progression; and ICH progression with mortality in patients with severe TBI. The causal relationship between coagulopathy and ICH progression will require further studies.
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Massive transfusion (MT) protocols improve survival in patients with exsanguinating hemorrhage. Both the increased plasma to red blood cells (RBC) and platelets to RBC ratios, and the "protocolization" of product delivery seem to be critical components of the reduction in mortality. The purpose of this study was to identify the incidence and impact of MT protocol noncompliance and to intervene in provider-related events associated with poor compliance and outcomes. ⋯ Early activation of a MT protocol and achieving predefined ratios was associated with improved survival. ED activation and direct blood bank notification by the trauma attending were associated with a reduction in blood product wastage. A multidisciplinary PI process helps to identify provider/specialty noncompliance and to assess the impact of these factors, and it was associated with improvement in compliance and MT outcomes over time.