Trauma centers verified by the American College of Surgeons (ACS) (and most states who perform their own designation visits) are required to engage in trauma prevention activities. Furthermore, ACS centers are required to provide prevention programs based on identified local needs. Frequently, trauma professionals see a pattern of injury in the patients they treat. This generally stimulates a search through their trauma registry. Reviewing registry data is the most direct way of identifying and confirming injury patters specific to the local population.
The next abstract for review describes the process and outcomes of such a project from a Level II center in Fort Walton Beach, Florida. They noted a pattern of diving injury and high cervical fractures. This was confirmed using 2016 registry data. Admitted patients were intensive resource users, with 71% requiring ICU admission and operative fixation, and nearly half requiring rehab admission upon discharge.
Based on this, they developed a “Think Before You Dive” program with posters, signs, swag (a custom koozie), a trifold brochure, and magnets with diving and water safety tips. Posters and flyers were provided to local business, and magnets were placed in hotel rooms in the area. One time-share company even placed a hard stop in their registration process so that visitors had to acknowledge the safety message.
What’s a koozie, you ask? I didn’t know the technical term for this, but here’s a picture:
Here are the factoids:
There was a reduction of 100% in cervical spine injuries, and 24% of all water-related incidents in the targeted area
All remaining diving/high-cord injuries came from outside the target area
It was estimated that costs were reduced by $1.2 million
As you can see, this is not the typical hard research paper usually provided at most scientific meetings. However, it is very important that this kind of information is presented, as it has the potential for impact on the other clinical research.
Here are some questions for the authors and presenter to consider in advance to help them prepare for audience questions:
How did you recognize the problem initially? Was it a pattern picked up by humans? Which ones (nurses, trauma physicians, therapists/rehab, others)?
Why did you think that your prevention approach would be effective?
Provide some details on how you convinced businesses to carry your message. Was there any resistance, and what were their arguments? How did you overcome it?
Show us the numbers. Although it may be difficult to show statistical differences in patient numbers, cost savings is important as well. Show the patient numbers pre- and post-intervention for the cluster area and outside of it.
Define how you arrived at your cost savings numbers. How do the previously published economic numbers relate to costs at your own center and those reported in this study?
I believe that this is important information, and will help many other centers properly design their own trauma prevention programs!
Reference: Using the trauma registry to guide your injury prevention programs. EAST 2019 Paper #18.
What goes around comes around. Fifty years ago, blood banks began fractionating whole blood into separate products so that specific component therapy could be administered. Over a relatively brief period of time, the switch to components became nearly complete, and whole blood was not available for civilian use. For decades, trauma professionals have had to treat our trauma patients losing whole blood, but having only components available to replace it. Unfortunately, taking blood apart and putting it back together just isn’t the same, as you can see below:
In recent years, there has been a significant movement to reintroduce whole blood. Many trauma centers are experimenting with it, and it seems we are having to relearn how to use it again. At last year’s EAST meeting, the US Army Institute of Surgical Research presented a paper that demonstrated improved survival in select severely injured patients. This year, an abstract from the University of Texas in Houston is being presented that explores the safety of giving whole blood.
This was a single-hospital study where cold-stored low titer type O whole blood (WB) was stocked in the center’s helicopters and emergency department. Components were also available. The center reviewed their 7 month experience with trauma patients who received either type of product. Their outcome variables were safety profile and transfusion reaction rates.
161 patients received component therapy and 95 received WB during the study period
ISS was statistically similar, but the abbreviated injury score for chest was higher in the whole blood group (see first two bullet points below)
Whole blood patients were more markedly impaired in the prehospital setting (higher pulse and lactate, lower blood pressure)
Whole blood patients received fewer units of products after leaving the ED, which is an 80% reduction when matched for the usual variables (0 vs 3)
Mortality was the same in the two groups (26% WB vs 22% component)
There was only one transfusion reaction, and it occurred in the component group
The authors concluded that whole blood appeared to be a safe alternative to 1:1 component therapy, and was associated with a reduced need for post-ED transfusion.
How were patients selected to receive components vs whole blood? Or were they? This could potentially influence many of the variables you analyzed (vital signs, lab values). Be sure to explain how selection bias may have influenced your results.
Some of your variables are statistically similar (i.e. ISS) but clinically different, or vice versa (24 hour bilirubin, chest AIS). Be prepared to explain why these results are or are not meaningful.
What do the terms safety profile and impact mean in your objectives section. You mention transfusion reaction rate separately, so what other safety and impact factors were you measuring?
Once again, statistical power is a question. Did you do a power analysis? I worry that a difference of 1 transfusion reaction in 250 patients was used to call whole blood safe.
How do you know the decrease in post-ED transfusions was due to use of whole blood? Please make sure to summarize the resuscitation given to the two groups while they were in the ED. Did the component group receive fewer units in the ED, thus requiring more afterwards? And vice versa for the whole blood group. Did they get more enroute to the hospital and in the ED?
This was a very interesting abstract. I’m looking forward to hearing many more details when you present.
Reference: Safety profile and impact of low-titer group O blood for emergency use in trauma. EAST 2019 Paper #16.
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