Herron Jonathan Blair Thomas, French R, Gilliam A D
Intensive Care, Defence Medical Group (DMG) North, Middlesbrough, UK.
General Surgery, County Durham and Darlington NHS Foundation Trust, Darlington, UK.
J R Army Med Corps. 2018 Jul;164(3):170-171. doi: 10.1136/jramc-2017-000814. Epub 2017 Oct 9.
Tranexamic acid (TXA) administration within the recommended time of 3 hours has been demonstrated to improve outcomes following trauma. The aim of this study was to identify potential knowledge gaps in the administration of TXA in order to target further educational training in those doctors responsible for the management of acute trauma.
104 military and 852 civilian doctors were invited to complete a four-item web-based questionnaire pertaining to the indications, dose, side effects and evidence base for TXA administration in trauma. Doctors of all grades and surgical specialties including emergency trainees and anaesthetics were surveyed.
65 military and 460 civilian doctors responded with a response rate of 62% and 54%, respectively. Responses were required for every question to allow progression and submission. 93% of military doctors knew the initial dose of TXA compared with 34% of civilian doctors. The Clinical randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH) 2 trial was known to 91% of military doctors compared with 24% of civilian doctors. The optimal time for delivery of TXA in under 3 hours was correctly identified by 91% of military doctors compared with 10% by civilian doctors.
Military doctors are more familiar with TXA and its side effect profile. Given the potential impact of TXA on patient outcome and the findings of this study, further education of all doctors is recommended including dose, timing and potential side effects.
已证明在推荐的3小时内给予氨甲环酸（TXA）可改善创伤后的预后。本研究的目的是确定TXA给药方面潜在的知识差距，以便针对负责急性创伤管理的医生进行进一步的教育培训。
邀请104名军事医生和852名 civilian医生完成一份基于网络的四项问卷，内容涉及TXA在创伤中的适应症、剂量、副作用和循证依据。对包括急诊实习生和麻醉医生在内的所有级别和外科专业的医生进行了调查。
65名军事医生和460名 civilian医生做出了回应，回应率分别为62%和54%。每个问题都需要做出回答才能继续并提交问卷。93%的军事医生知道TXA的初始剂量，而 civilian医生中这一比例为34%。91%的军事医生知道“重大出血中抗纤溶药物的临床随机试验（CRASH）2”，而 civilian医生中这一比例为24%。91%的军事医生正确识别出TXA在3小时内给药的最佳时间，而 civilian医生中这一比例为10%。
军事医生更熟悉TXA及其副作用情况。鉴于TXA对患者预后的潜在影响以及本研究的结果，建议对所有医生进行进一步教育，包括剂量、给药时间和潜在副作用。
