BackgroundTranexamic Acid (TXA) is an anti-fibrinolytic agent that promotes haemostasis and counteracts coagulopathy in trauma. A wealth of research supports TXA use in adults, yet no large trials ...have been performed in paediatric populations. The RCPCH in 2012 advocated TXA use in paediatric trauma, recommending future evaluation of outcomes utilising the Trauma Audit and Research Network (TARN).ObjectivesTo describe TXA use in paediatric trauma over time, exploring association with best practice statements and evidence from adult trials. Primary outcome was to determine change in prevalence of use over time. Secondary outcomes captured details or impact of change, including thrombotic events, blood product use, surgical intervention, and evaluation of injury patterns.MethodsRetrospective analysis of TARN data between 2008–2020 for patients under 16 years in England and Wales, with no clinical exclusions.A time series analysis was performed, with descriptive statistics given as mean (95% CI) or median (IQR)Results27,385 patients were included of which 18535 (67.7%) were male. 7804 (28.5%) were aged 12–15, 6966 (25.4%) aged 6–11, 6570 (24%) aged 2–5 and 6045 (22.1%) under 1. Overall mortality within 30 days was 799 (2.9%).TXA use increased year on year, from 25 (1.2%) in 2012 to 196 (10.1%) in 2020. Apart from an initial rapid rise in use in 2012–2013, no other annual progression showed a disproportionate increase. There was no change in 30-day mortality rate over time, ranging between 2.1% (in 2015) and 3.3% (in 2016). Change over time analysis showed no significant increase in thrombotic complications. In 2012 data revealed 4 (0.2%) thrombotic events compared to 2 (0.1%) in 2020, with a tenfold increase in TXA over same time period.In total, 1346 (4.9%) patients received TXA, of which 735 (54.6%) were aged 12–15. Road traffic collisions (64%) and penetrating injuries (12.7%) were the commonest mechanisms of injury in those receiving TXA. In relation to trauma severity, the median Injury Severity Score in those treated with TXA was 20 IQR 10–33, compared to 9 IQR 9–16 in untreated patients; 829 (61%) of those treated with TXA were admitted to ICU, compared to 4849 (18.6%) without. Blood products were transfused in 245 (18.2%) patients receiving TXA compared to 110 (0.4%).ConclusionsWe have demonstrated consistent increases in proportional use of TXA over time since the RCPCH statement in 2012, with no change in mortality. Despite significant increase in TXA use, the incidence of thrombotic events has remained stable. Within the constraints of the small rate of adverse events in this large cohort, there is no evidence to suggest harm following TXA treatment.TXA is more likely to be given in those aged 12–15 years. This may be explained by different trauma patterns, with road traffic accidents and penetrating injuries more common in older children. Administration of blood products and ICU admission were strongly associated with administration of TXA. Further analyses of change over time are ongoing for secondary outcome analyses
Lately, the care of severely injured patients in the United Kingdom has undergone a significant transformation. The establishment of regional trauma networks (RTN) with designated Major Trauma ...Centers (MTCs) and satellite hospitals called Trauma Units (TUs) has centralized the care of severely injured patients in the MTCs.
Pelvic fractures are notoriously linked with hypovolemic shock or even death from excessive blood loss. The aim of this prospective cohort study is to compare the profile of severely injured patients with combined pelvic fractures and their mortality between two different distinct eras of an advanced healthcare system. Anonymized consecutive patient records submitted to TARN UK between 2002 and 2017 by NHS England hospitals were analyzed. Records of patients without a pelvic fracture, or with isolated pelvic fractures (no other serious injury with abbreviated injury scale AIS >2) were excluded.
All patients with known outcomes were included and were divided into 2 distinct periods (pre-RTN era: between January 2002 and March 2008 (control group); and RTN era April 2013 to June 2017 (study group)). Data from the transition period from April 2008 to March 2013 were excluded to minimize the effect of variations between the developing networks and MTCs during that era. Overall, the study group included 10,641 patients, whereas the control group was 3152 patients, with a median age of 52.4 and 35.1 years and an ISS of 24 and 27 respectively. A systolic blood pressure below 90mmHg was observed in 7.2% of patients in the study group and 10.4% in the control group. A significant increase of the median time to death (from 8hrs to 188hrs) was observed between the two eras. The cumulative mortality of severely injured patients with pelvic fractures decreased significantly from 17.8% to 12.4% (p<0.0001).
The recorded improvement of survivorship in the subgroup of severely injured patients with a pelvic fracture (32% lower in the post-RTN than in the pre-RTN period: OR 1.32 (95% CI 1.21 – 1.44), following the first 5 years of established regional trauma networks in NHS England, is encouraging, and should be attributed to a wide range of factors that translate to all levels of trauma care.
ObjectivesIn the last 10 years there has been a significant increase in cycle traffic in the UK, with an associated increase in the overall number of cycling injuries. Despite this, and the ...significant media, political and public health debate into this issue, there remains an absence of studies from the UK assessing the impact of helmet use on rates of serious injury presenting to the National Health Service (NHS) in cyclists.SettingThe NHS England Trauma Audit and Research Network (TARN) Database was interrogated to identify all adult (≥16 years) patients presenting to hospital with cycling-related major injuries, during a period from 14 March 2012 to 30 September 2017 (the last date for which a validated dataset was available).Participants11 192 patients met inclusion criteria. Data on the use of cycling helmets were available in 6621 patients.Outcome measuresTARN injury descriptors were used to compare patterns of injury, care and mortality in helmeted versus non-helmeted cohorts.ResultsData on cycle helmet use were available for 6621 of the 11 192 cycle-related injuries entered onto the TARN Database in the 66 months of this study (93 excluded as not pedal cyclists). There was a significantly higher crude 30-day mortality in un-helmeted cyclists 5.6% (4.8%–6.6%) versus helmeted cyclists 1.8% (1.4%–2.2%) (p<0.001). Cycle helmet use was also associated with a reduction in severe traumatic brain injury (TBI) 19.1% (780, 18.0%–20.4%) versus 47.6% (1211, 45.6%–49.5%) (p<0.001), intensive care unit requirement 19.6% (797, 18.4%–20.8%) versus 27.1% (691, 25.4%–28.9%) (p<0.001) and neurosurgical intervention 2.5% (103, 2.1%–3.1%) versus 8.5% (217, 7.5%–9.7%) (p<0.001). There was a statistically significant increase in chest, spinal, upper and lower limb injury in the helmeted group in comparison to the un-helmeted group (all p<0.001), though in a subsequent analysis of these anatomical injury patterns, those cyclists wearing helmets were still found to have lower rates of TBI. In reviewing TARN injury codes for specific TBI and facial injuries, there was a highly significant decrease in rates of impact injury between cyclists wearing helmets and those not.ConclusionsThis study suggests that there is a significant correlation between use of cycle helmets and reduction in adjusted mortality and morbidity associated with TBI and facial injury.
Ocular trauma is a significant cause of blindness and is often missed in polytrauma. No contemporary studies report eye injuries in the setting of severe trauma in the UK. We investigated ocular ...injury epidemiology and trends among patients suffering major trauma in England and Wales from 2004 to 2021.
We conducted a retrospective study utilising the Trauma Audit and Research Network (TARN) registry. Major trauma cases with concomitant eye injuries were included. Major trauma was defined as Injury Severity Score >15. Ocular injuries included globe, cranial nerve II, III, IV, and VI, and tear duct injuries. Orbital fractures and adnexal and lid injuries were not included. Demographics, injury profiles, and outcomes were extracted. We report descriptive statistics and 3-yearly trends.
Of 287 267 major trauma cases, 2368 (0.82%) had ocular injuries: prevalence decreased from 1.87% to 0.66% over the 2004-2021 period (P < 0.0001). Males comprised 72.2% of ocular injury cases, median age was 34.5 years. The proportion of ocular injuries from road traffic collisions fell from 43.1% to 25.3% while fall-related injuries increased and predominated (37.6% in 2019/21). Concomitant head injury occurred in 86.6%. The most common site of ocular injury was the conjunctiva (29.3%). Compared to previous TARN data (1989-2004), retinal injuries were threefold more prevalent (5.9% vs 18.5%), while corneal injuries were less (31.0% vs 6.6%).
Whilst identifying eye injuries in major trauma is challenging, it appears ocular injury epidemiology in this setting has shifted, though overall prevalence is low. These findings may inform prevention strategies, guideline development and resource allocation.
We aimed to compare adolescent mortality rates between different types of major trauma centre (MTC or level 1; adult, children's and mixed).
Data were obtained from TARN (Trauma Audit Research ...Network) from English sites over a 6-year period (2012-2018), with adolescence defined as 10-24.99 years. Results are presented using descriptive statistics. Patient characteristics were compared using the Kruskal-Wallis test with Dunn's post-hoc analysis for pairwise comparison and χ
test for categorical variables.
21 033 cases met inclusion criteria. Trauma-related 30-day crude mortality rates by MTC type were 2.5% (children's), 4.4% (mixed) and 4.9% (adult). Logistic regression accounting for injury severity, mechanism of injury, physiological parameters and 'hospital ID', resulted in adjusted odds of mortality of 2.41 (95% CI 1.31 to 4.43; p=0.005) and 1.85 (95% CI 1.03 to 3.35; p=0.041) in adult and mixed MTCs, respectively when compared with children's MTCs. In three subgroup analyses the same trend was noted. In adolescents aged 14-17.99 years old, those managed in a children's MTC had the lowest mortality rate at 2.5%, compared with 4.9% in adult MTCs and 4.4% in mixed MTCs (no statistical difference between children's and mixed). In cases of major trauma (Injury Severity Score >15) the adjusted odds of mortality were also greater in the mixed and adult MTC groups when compared with the children's MTC. Median length of stay (LoS) and intensive care unit LoS were comparable for all MTC types. Patients managed in children's MTCs were less likely to have a CT scan (46.2% vs 62.8% mixed vs 64% adult).
Children's MTC have lower crude and adjusted 30-day mortality rates for adolescent trauma. Further research is required in this field to identify the factors that may have influenced these findings.
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