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  • Mitra, Biswadev  (10)
  • Gruen, Russell L.  (10)
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  • 1
    Language: English
    In: The Lancet, 2011, Vol.377(9771), pp.1052-1054
    Description: Unlike coagulopathy that is secondary to haemodilution, hypothermia, or acidosis, acute traumatic coagulopathy is a hyperacute process in which systemic fibrinolysis releases D-dimers that are detectable within 30 min of injury.5 While the mechanisms are poorly understood, shock and tissue injury seem...
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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  • 2
    Language: English
    In: The Lancet, 2010, Vol.376(9746), pp.1049-1049
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
    Source: ScienceDirect Journals (Elsevier)
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  • 3
    Language: English
    In: Injury, 2012, Vol.43(1), pp.33-37
    Description: A high ratio of fresh frozen plasma (FFP) to packed red blood cells (PRBC) is currently recognised as the standard of care in some centres during massive transfusion post trauma. The aim of this study was to test whether the presumption of benefit held true for severely injured patients who received a massive transfusion, but did not present with acute traumatic coagulopathy. Data collected in The Alfred Trauma Registry over a 6 year period were reviewed. Included patients were sub-grouped by a high FFP:PRBC ratio (≥1:2) in the first 4 h and compared to patients receiving a lower ratio. Outcomes studied were associations with mortality, hours in the intensive care unit and hours of mechanical ventilation. Of 4164 eligible patients, 374 received a massive transfusion and 179 (49.7%) patients who did not have coagulopathy were included for analysis. There were 66 patients who received a high ratio of FFP:PRBC, and were similar in demographics and presentation to 113 patients who received a lower ratio. There was no significant difference in mortality between the two groups ( = 0.80), and the FFP:PRBC ratio was not significantly associated with mortality, ICU length of stay or mechanically ventilated hours. A small proportion of major trauma patients received a massive blood transfusion in the absence of acute traumatic coagulopathy. Aggressive FFP transfusion in this group of patients was not associated with significantly improved outcomes. FFP transfusion carries inherent risks with substantial costs and the population most likely to benefit from a high FFP:PRBC ratio needs to be clearly defined.
    Keywords: Wounds and Injuries ; Blood Coagulation Disorders ; Blood Transfusion ; Resuscitation
    ISSN: 0020-1383
    E-ISSN: 1879-0267
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  • 4
    In: European Journal of Emergency Medicine, 2011, Vol.18(3), pp.137-142
    Description: OBJECTIVES: ‘Massive’ transfusion is a poorly defined inclusion criteria for studies examining the blood and blood product that are used during trauma resuscitation. We aimed to compare the traditional definition of massive transfusion (≥10 units in 24 h) to a more acute definition of at least 5 units in 4 h. METHODS: Multitrauma patients were subgrouped according to the traditional definition and compared with the acute definition. Demographics, presenting vital signs and blood results, management including transfusion practice and outcomes were retrospectively studied. Associations of transfused fresh frozen plasma:packed red blood cells (PRBC) ratios with mortality were studied. RESULTS: There were 927 patients who received PRBCs in the first 24 h, with 314 patients identified using the traditional definition and 303 patients using the acute definition. The patients identified using the traditional definition received 18 (12–29) units of PRBC in 24 h, significantly higher than those identified using the acute definition [15 (9–29) units, P〈0.001]. The traditional definition excluded a significant proportion of patients who died in the emergency department. By using the acute definition to select a study sample, there seems to be an increase in mortality with fresh frozen plasma:PRBC ratio of 1 : 1 ratio compared with a 1 : 2 ratio. CONCLUSION: The traditional ‘massive’ transfusion definition not only ‘dilutes’ the potential study samples with a less acute group of patients, but also further excludes patients who die early. This latter group is most likely to be benefitted from any change to resuscitation practice. An acute definition of massive transfusion should be adopted when examining clinical practice during initial trauma resuscitation.
    Keywords: Blood Transfusion -- Methods ; Resuscitation -- Methods ; Wounds and Injuries -- Complications;
    ISSN: 0969-9546
    E-ISSN: 14735695
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  • 5
    In: Emergency Medicine Australasia, April 2014, Vol.26(2), pp.194-197
    Description: Following findings of the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH‐2) trial, tranexamic acid () use post trauma is becoming widespread. However, issues of generalisability, applicability and predictability beyond the context of study sites remain unresolved. Internal and external validity of the ‐2 trial are currently lacking and therefore incorporation of into routine trauma resuscitation guidelines appears premature. The Pre‐hospital Antifibrinolytics for Traumatic Coagulopathy and Haemorrhage (PATCH)‐Trauma study is a National Health and Medical Research Council‐funded randomised controlled trial of early administration of in severely injured patients likely to have acute traumatic coagulopathy. The study population chosen has high mortality and morbidity and is potentially most likely to benefit from 's known mechanisms of action. This and further trials involving appropriate sample populations are required before evidence based guidelines on use during trauma resuscitation can be developed.
    Keywords: Evidence‐Based Practice ; Haemorrhage ; Resuscitation ; Tranexamic Acid ; Wounds And Injuries
    ISSN: 1742-6731
    E-ISSN: 1742-6723
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  • 6
    In: Journal of Evidence‐Based Medicine, August 2017, Vol.10(3), pp.212-221
    Description: Byline: Anneliese Synnot, Adrian Karlsson, Lisa Brichko, Melissa Chee, Mark Fitzgerald, Mahesh C Misra, Teresa Howard, Joseph Mathew, Thomas Rotter, Michelle Fiander, Russell L Gruen, Amit Gupta, Satish Dharap, Madonna Fahey, Michael Stephenson, Gerard O'Reilly, Peter Cameron, Biswadev Mitra, Keywords: advanced trauma life support care; emergency medical service communication systems; prehospital emergency care; review; systematic; trauma Abstract Objective This systematic review aimed to determine the effect of prehospital notification systems for major trauma patients on overall (〈30 days) and early (〈24 hours) mortality, hospital reception, and trauma team presence (or equivalent) on arrival, time to critical interventions, and length of hospital stay. Methods Experimental and observational studies of prehospital notification compared with no notification or another type of notification in major trauma patients requiring emergency transport were included. Risk of bias was assessed using the Cochrane ACROBAT-NRSI tool. A narrative synthesis was conducted and evidence quality rated using the GRADE criteria. Results Three observational studies of 72,423 major trauma patients were included. All were conducted in high-income countries in hospitals with established trauma services, with two studies undertaking retrospective analysis of registry data. Two studies reported overall mortality, one demonstrating a reduction in mortality; (adjusted odds ratio (OR) 0.61, 95% confidence interval (CI) 0.39 to 0.94, 72,073 participants); and the other demonstrating a nonsignificant change (OR 0.61, 95% CI 0.23 to 1.64, 81 participants). The quality of this evidence was rated as very low. Conclusion Limited research on the topic constrains conclusive evidence on the effect of prehospital notification on patient-centered outcomes after severe trauma. Composite interventions that combine prehospital notification with effective actions on arrival to hospital such as trauma bay availability, trauma team presence, and early access to definitive management may provide more robust evidence towards benefits of early interventions during trauma reception and resuscitation. Article Note: Funding information The review was conducted as part of the Australia-India Trauma Systems Collaboration, funded by the Australian Government Department of Industry, Innovation and Science GCF020013 and the Indian Government Department of Science and Technology through the Australia-India Strategic Research Fund Grand Challenge Scheme. The study sponsors had no role in the review design, collection, analysis or interpretation of data, writing of the manuscript or decision to submit the manuscript for publication. CAPTION(S): ONLINE APPENDIX Appendix A. Searches run in June 2015 Appendix B. Search Strategies run in March 2015 Appendix C. KEY excluded studies table
    Keywords: Advanced Trauma Life Support Care ; Emergency Medical Service Communication Systems ; Prehospital Emergency Care ; Review ; Systematic ; Trauma
    ISSN: 1756-5391
    ISSN: 17565383
    E-ISSN: 1756-5391
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  • 7
    Language: English
    In: European journal of trauma and emergency surgery : official publication of the European Trauma Society, 29 April 2019
    Description: Early identification of trauma patients at risk of developing acute traumatic coagulopathy (ATC) is important for initiating appropriate, coagulopathy-focused treatment. A clinical ATC prediction tool is a quick, simple method to evaluate risk. The COAST score was developed and validated in Australia but is yet to be validated on a European population. We validated the ability of the COAST score to predict coagulopathy and adverse bleeding-related outcomes on a large European trauma population. The COAST score was modified and applied to a retrospective cohort of trauma patients from the German Trauma Registry (TR-DGU). The primary outcome was coagulopathy defined as INR 〉 1.5 or aPTT 〉 60 s. Secondary outcomes were massive transfusion, blood product requirements, urgent surgery and mortality. The cohort included adult trauma patients with Injury Severity Score 〉 15 treated in Germany/Austria in 2012-2016. 15,370 cases were included, of which 10.9% were coagulopathic. The COAST score performed with sensitivity 21.6% and specificity 94.2% at a threshold of COAST ≥ 3. The AUROC was 0.625 (95% CI 0.61-0.64). The COAST score also identified patients who had more massive transfusions (15.3% v 1.6%), more emergency surgery (49.6% v 28.2%), and higher early (21.7% v 5.4%) and total in-hospital mortality (38.1% v 14.5%). This large retrospective study demonstrated that the modified COAST score predicts coagulopathy with low sensitivity but high specificity. A positive COAST score identified a group of patients with bleeding-related adverse outcomes. This score appears adequate to act as an inclusion criterion for clinical trials targeting ATC.
    Keywords: Acute Traumatic Coagulopathy ; Bleeding ; Blood Coagulation Disorders ; Prediction Model ; Prediction Score ; Trauma
    ISSN: 18639933
    E-ISSN: 1863-9941
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  • 8
    In: Medicina, 2019, Vol.55(10)
    Description: Background and objectives: Prompt identification of patients with acute traumatic coagulopathy (ATC) is necessary to expedite appropriate treatment. An early clinical prediction tool that does not require laboratory testing is a convenient way to estimate risk. Prediction models have been developed,...
    Keywords: Review ; Acute Traumatic Coagulopathy ; Prediction Model ; Pre-Hospital ; Bleeding ; Trauma
    ISSN: 1010-660X
    E-ISSN: 1648-9144
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  • 9
    Language: English
    In: World journal of surgery, October 2019, Vol.43(10), pp.2426-2437
    Description: The completeness of a trauma registry's data is essential for its valid use. This study aimed to evaluate the extent of missing data in a new multicentre trauma registry in India and to assess the association between data completeness and potential predictors of missing data, particularly mortality. The proportion of missing data for variables among all adults was determined from data collected from 19 April 2016 to 30 April 2017. In-hospital physiological data were defined as missing if any of initial systolic blood pressure, heart rate, respiratory rate, or Glasgow Coma Scale were missing. Univariable... Data on the 4466 trauma patients in the registry were analysed. Out of 59 variables, most (n = 51; 86.4%) were missing less than 20% of observations. There were 808 (18.1%) patients missing at least one of the first in-hospital physiological observations. Hospital death was associated with missing in-hospital... Most variables were well collected. Hospital death, a proxy for more severe injury, was associated with missing first in-hospital physiological observations. This remains an important limitation for trauma registries.
    Keywords: Heart Rate -- Analysis;
    ISSN: 03642313
    E-ISSN: 1432-2323
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  • 10
    In: ANZ Journal of Surgery, December 2013, Vol.83(12), pp.918-923
    Description: Byline: Biswadev Mitra, Gerard O'Reilly, Peter A. Cameron, Amanda Zatta, Russell L. Gruen Keywords: blood component transfusion; blood transfusion; emergency medicine; fresh frozen plasma; resuscitation Abstract Introduction The effectiveness of massive transfusion protocols (MTPs) has been assumed from low quality studies with multiple biases. This review aimed to (i) evaluate the association between the institution of an MTP and mortality and (ii) determine the effect of MTPs on transfusion practice post trauma. Methods A systematic review of studies that examined patient outcomes before and after the institution of an MTP in the same centre was conducted. The design and results of each study were described. Heterogeneity was assessed using the Q test and the I.sub.2 statistic. Odds ratios (ORs) for dichotomous outcomes from each study were pooled. Results There were eight studies that satisfied inclusion criteria with marked heterogeneity in study populations (I.sub.2 = 72.1%, P = 0.001). Two studies showed significantly improved mortality following implementation of an MTP, and six studies showed no significant change. Pooled OR for the effect of an MTP on short-term mortality was 0.73 (95% confidence interval: 0.48-1.11). The effect of MTPs on transfusion practice was varied. Conclusion Despite the popularity of MTPs and directives mandating their use in trauma centres, in before-after studies, MTPs have not always been associated with improved mortality. Evidence-based standardization of MTPs, improved compliance and analysis of broader endpoints were identified as areas for further research. Article Note: B. Mitra MBBS, MHSM, PhD, FACEM; G. O'Reilly MBBS, MPH, MBiostat, FACEM; P. A. Cameron MBBS, MD, FACEM; A. Zatta BSc (Hons), PhD; R. L. Gruen MBBS, PhD, FRACS.
    Keywords: Blood Component Transfusion ; Blood Transfusion ; Emergency Medicine ; Fresh Frozen Plasma ; Resuscitation
    ISSN: 1445-1433
    E-ISSN: 1445-2197
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