IntroductionTranexamic acid (TXA) reduces bleeding and mortality. Recent trials have demonstrated improved survival with shorter intervals to TXA administration. The aims of this service evaluation were to assess the interval from injury to TXA administration and describe the characteristics of patients who received TXA pre-hospital and in-hospital.MethodsWe reviewed Trauma and Audit Research Network records and local trauma registries to identify patients of any age that received TXA at all London Major Trauma Centres and Queen’s Medical Centre, Nottingham, during 2017. We used the 2016 NICE Guidelines (NG39) which state that TXA should be given within 3 hours of injury.ResultsWe identified 1018 patients who received TXA, of whom 661 (65%) had sufficient data to assess the time from injury to TXA administration. The median interval was 74 min (IQR: 47–116). 92% of patients received TXA within 3 hours from injury, and 59% within 1 hour. Half of the patients (54%) received prehospital TXA. The median time to TXA administration when given prehospital was 51 min (IQR: 39–72), and 112 min (IQR: 84–160) if given in-hospital (p<0.001). In-hospital TXA patients had less haemodynamic derangement and lower base deficit on admission compared with patients given prehospital TXA.ConclusionPrehospital administration of TXA is associated with a shorter interval from injury to drug delivery. Identifying a proportion of patients at risk of haemorrhage remains a challenge. However, further reinforcement is needed to empower pre-hospital clinicians to administer TXA to trauma patients without overt signs of shock.

Aim The aim of this study was to assess the accuracy of quotations of the Proximal Fracture of the Humerus Evaluation by Randomization (ProFHER) study in the published literature. Methods A literature search was performed from March 2015 to November 2019 to identify all papers that reference ProFHER since its publication. Full text articles were reviewed by two independent reviewers using a validated framework of assessing quotation errors. A kappa co-efficient was calculated to assess interobserver reliability of the reviewers. Results There were 260 individual ProFHER quoted references within the 138 included articles. We identified 35/260 quotation errors (13%). Of these, 10/35 (29%) were major quotation errors and 25/35 (71%) minor quotation errors. There was substantial interobserver agreement when errors were classified. Of the 10 major errors, six quotations were not substantiated by the results of ProFHER and three were unrelated to ProFHER. One paper contained a quotation error that contradicted the results of ProFHER. Of the 25 minor errors, 19 oversimplified or generalised the conclusions of ProFHER and six contained numerical or grammatical errors. Conclusion The current study demonstrated substantial inaccuracies in quotations of the Proximal Fracture of the Humerus Evaluation by Randomization study. Vigilance is recommended when quoting the literature and reviewing submitted papers in order to prevent the perpetuation of misquoted data.

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Aims Robotic incisional/ventral hernia repair (R-IVHR) is gaining popularity due to higher safety as well as feasibility profile. The objective of this study is to present a systematic review exploring the role of robotics compared to laparoscopic approach in the management of incisional/ventral hernia. Methods A systematic review of all types of comparative studies until January 2021 published on Embase, Medline, PubMed, PubMed Central and Cochrane databases reporting the clinical outcomes in patients undergoing either R-IVHR versus Laparoscopic (L-IVHR) was performed. Results A total of 8289 patients in 7 studies were included. There was minimal heterogeneity (Tau2 = 0.29, chi2 = 9.10, df, I2 = 45 %) among included studies for the variables of recurrence rate and post-operative complications, but statistically significant heterogeneity (Tau2 = 1.05, chi2 = 132.81, I2 = 96 %) was observed for the duration of operation. In the random effects model analysis using the statistical software Review Manager, statistically the R-IVHR prolonged the duration of operation (Standardized mean difference, 2.24; 95% CI, 1.37, 3.11; z = 5.06; P = 0.00001) but the post-operative complication rate (OR 0.63; 95% CI, 0.30, 1.34; z = 1.20; P = 0.23) as well as the recurrence rate (OR 0.63; 95% CI, 0.14, 2.74; z = 0.62; P = 0.53) were similar. Conclusion R-IVH repair is feasible and safe, but the duration of operation is significantly longer. Major multi-center randomized controlled trial is mandatory to assess the long terms outcomes and cost effectiveness before the routine use of R-IVHR.