Ghawnni Abeer, Coates Angela, Owen Julian
*Trauma Program,Hamilton Health Sciences and McMaster University,Hamilton,ON.
CJEM. 2018 Mar;20(2):216-221. doi: 10.1017/cem.2017.349. Epub 2017 Jul 4.
Introduction Current practice for the treatment of traumatic hemorrhage includes fluid resuscitation and the administration of blood products. The administration of tranexamic acid (TXA) within 8 hours of injury has been shown to significantly reduce mortality in a large, prospective, randomized controlled trial. As a result, TXA is widely used in trauma centres to manage trauma patients with major bleeding. The primary aim of this study was to assess the compliance of TXA administration at a level-one trauma centre in Hamilton, Ontario, Canada.
We conducted a retrospective medical record review of consecutive adult trauma patients received at the Hamilton General Hospital between January 1, 2012 and December 31, 2014. Compliance with TXA administration was based on the inclusion criteria of the CRASH-2 trial.
Five hundred and thirty-four of 2,475 trauma patients met the inclusion criteria for TXA administration. Twenty-one patients who received TXA at peripheral hospital prior to their arrival at the level-one trauma centre were excluded from the analysis, and 18 patients were excluded due to missing data. One hundred and thirty-four patients received TXA, representing a compliance rate of 27%. Mean time from arrival to TXA administration was 47 minutes. Compliance increased for those who required massive transfusion and as the number of criteria for TXA administration increased.
Compliance with TXA administration to trauma patients with suspected major bleeding was low. Quality improvement strategies aimed at increasing appropriate use of TXA are warranted.
引言 目前创伤性出血的治疗方法包括液体复苏和输注血液制品。在一项大型前瞻性随机对照试验中，已证明在受伤后8小时内给予氨甲环酸（TXA）可显著降低死亡率。因此，TXA在创伤中心被广泛用于治疗大出血的创伤患者。本研究的主要目的是评估加拿大安大略省汉密尔顿一家一级创伤中心TXA给药的依从性。
我们对2012年1月1日至2014年12月31日期间在汉密尔顿综合医院接收的连续成年创伤患者进行了回顾性病历审查。TXA给药的依从性基于CRASH-2试验的纳入标准。
2475例创伤患者中有534例符合TXA给药的纳入标准。21例在到达一级创伤中心之前在外围医院接受TXA治疗的患者被排除在分析之外，18例因数据缺失被排除。134例患者接受了TXA治疗，依从率为27%。从到达医院到给予TXA的平均时间为47分钟。对于需要大量输血的患者以及TXA给药标准数量增加的患者，依从性有所提高。
对疑似大出血的创伤患者给予TXA的依从性较低。有必要采取旨在增加TXA合理使用的质量改进策略。
