The Journal of surgical research
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Review
Trauma registry implementation in low- and middle-income countries: challenges and opportunities.
Trauma registries are an essential part of trauma quality improvement programs aimed at decreasing morbidity and mortality in high-income countries. In low- and middle-income countries (LMICs), where the burden of injury is disproportionately high, hospitals have faced challenges in adapting trauma registry models implemented in high-income countries. We analyze the barriers to trauma registry implementation in LMICs to inform development of sustainable models in resource-constrained settings. ⋯ Many LMICs face unique challenges to implementation that must be overcome to create sustainable trauma databases. Understanding these barriers and taking steps to evaluate the effectiveness of proposed solutions may further improve trauma care to address the high burden in these settings.
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Patients with traumatic intracranial hemorrhage (TIH) anticoagulated with warfarin are at an increased risk of mortality. Fresh frozen plasma (FFP) and vitamin K have been the standard treatment for warfarin reversal; however, guidelines now recommend the use of prothrombin complex concentrate (PCC) for warfarin reversal in patients with life-threatening bleeding. Our protocol uses one vial (∼1000 units) of activated PCC (aPCC) for warfarin reversal, regardless of the weight or presenting international normalized ratio (INR). The purpose of this study was to determine the safety and efficacy of using fixed, low-dose aPCC for warfarin reversal in patients with TIH. ⋯ Fixed, low-dose aPCC is safe and more effective at reversing the effects of warfarin than FFP in patients with TIH.